FINANCING UNIVERSAL HEALTH COVERAGE-CAN IT BE DONE IN ZIMBABWE?
The World health Organization enshrined in its constitution in 1948 that Health is a fundamental Human right, Fast forward almost 70 years and, the successes appear dwarfed by the failures as far as fulfilling Health for all is concerned.
The Sustainable development Goals have given nations around the world a renewed vigor to pursue relentlessly the elusive dream of universal health coverage. The basic definition of Universal Health Coverage(UHC) is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. Out O f Pocket (OOP)payment for healthcare is a developmental issue of concern with over 100 million people being pushed into poverty per year after paying OOP,It is safe to conclude that no country and its people can develop when its people are not adequately covered by health insurance or medical aid of one form or the other.
THE IDEAL INSURANCE SCENARIO
The scenario that can pay for universal access has the following attributes
- Ability to collect large pools of prepaid funds that can be used to pay for healthcare cost
- Responsible sharing of resources to spread financial risk
- Premiums that are within the reach of more than 80 percent of the population
- Today less than 10 percent of Zimbabwe’s population is covered under medical aid
- Over 12 million people have to pay for healthcare Out Of Pocket
- Over 80 percent of the population is not formally employed!!!
The 3 primary drivers of the decline in insured are:
- a breakdown in the current system due to poor relations between many existing insurers and doctors stemming from non-payment and long lead times for payments, an increasing demand for up-front cash calls and circumvention of the system as actors mistrust and circumvent current structures and declining levels of customer service
- a significant shift away from employer sponsored health insurance leading to a decline in the number of insured.
- failure of the existing health care providers to properly adjust to and cater for the burgeoning informal sector (estimated at between USD$ 3 – 7bn)1 that is not being serviced/cannot access premiums under the current system (although some companies have low premiums, many require a pay slip)
Ultramed was incorporated in 2015 with the objective of providing basic, no-frills medical aid cover to the population at a fraction of what the market currently charges
The key features of Ultramed’s operating model are:
Affordable premiums from as little as USD5 per month with the key target market being the informal sector (which, currently comprises ~95%2 of the economically active population but is generally not covered by existing medical aid providers), up to USD 140 per month for the premium packages which includes specialists, dental and private hospital cover
A centralized hub and spoke operating model that leverages strong relationships with a network of Doctors and pharmacists across Zimbabwe and the use of technology and innovative payment systems such as e-money to reduce face to face time and administrative costs so that services can be provided more efficiently and at a significantly reduced rate
Strategic partnerships with money transfer organizations such as Western Union and Money gram to enable the Zimbabwean Diaspora which remits ~USD1 Billion (estimated to be up to double this amount if including informal remissions), to be able to make direct payments to cover their relative’s health care costs in Zimbabwe (1st in the market to do so)
Provision of generic drugs to further reduce the cost of care wherever possible vs high costs brand names
THE BIG QUESTION
The Big Question is ,how do you afford to cover adequately someone paying 120 USD a year(for a 10 USD a month premium for medical aid?)When the cost of Healthcare services in Zimbabwe, far outmatches other countries in the region.The average cost of seeing a general practitioner is in the region 8usd-15usd in the region but 35usd in Zimbabwe, the same costly structure applies across the health services spectrum to the end that it is cheaper to fly to India spend 3 weeks there receiving hotel service get surgery done and fly back than it is to get the same procedure done by a local surgeon in Harare.
The answer to the question above lye’s in an exhaustive exploration of the current system and its inefficiencies and structure of our healthcare system and why it isn’t working for the purposes of universal health care.
We know, based on studies of many countries that the gatekeeper to healthcare services is the general practitioner and likewise must be accorded the chance to lead the care of patient care in what we term the Gp led system, currently Zimbabwe’s health service is specialist led, not only is this unsustainable ,it costs too much to the financiers of healthcare.
The referral system and the primary health care concept worked wonders in Zimbabwe from independence and tracking of the outcomes in that era showed many successes which were scored.90 percent of cases can be effectively managed by the General practitioner(who needs to undergo continual medical education to stay on top of the situation),continual training of the General practioner also helps to change the prescribing behavior of doctors which is one of the major reasons our healthcare costs too much.
Below is a table showing the advantages of a GP LED SYSTEM VERSUS A SPECIALIST LED SYSTEM and it is apparent that the tenets and ambitions of universal health coverage are better achieved in a system where everyone is registered to one Family practioner and any referrals to a specialist are not indefinite but once patient is stable they are referred back to the General practitioner
|Non FP Specialist Care Orientated Health Delivery System||Primary Care Orientated Health Delivery System|
|Focus on Specialist Care||Focus on Preventative Care (Both Primary and Secondary Prevention)|
|Focus on single disease or single system||Comprehensive and Holistic care, addressing the full range of patient needs “From Cradle to Grave”|
|Multiple diseases can lead to short term fragmented care||Continuity of care with coordinated information related management designed to provide integrated long term care|
|Individual patient focus||Family, community and population health considerations when addressing health needs|
|Payment approaches (Mainly Fee For Service) do not encourage quality assessment and resultantly quality improvement.||Some countries under Universal Health Care use a capitation model that may be based on performance and health outcomes. This fosters quality assessment and improvement|
TECHNOLOGY AND THE HUB AND SPOKE SYSTEM
My final teaser is on the need to adopt a more active use of relevant, available and accessible technology to kill inefficiencies in the healthcare system, this discuss is incomplete without stressing the need to tap into mobile technology for both our wellness interventions and easy premium collection.
Much of the inefficiencies of our system comes from inadequate and improper use of data, big or small, hence the system we are advocating for as has been by other players in the market is the use of biometrics, to curb medical l aid fraud among other forms of new technology but we are most excited about the mobile platform as Zimbabwe has a mobile penetration way into the late 90s.
The info graphic above shows how telemedicine and the service network we are building will be linked in a central hub which processes all data for mapping of disease patterns and patient patterns as well service provider behaviors and needs, this will be a big data system that will churn out intervention responses tailor made to the particular communities for more efficient responses.
What use is education, if our learning fails to save lives but rather create limitations for access, It is in my view the responsibility of every healthcare professional to innovate and find ways for the system to let in more people which ultimately translates to dollars
- Planning for Primary Health care in Zimbabwe, and approach to the functional intergrationof Primary health care and support by the health system; a dissertation submitted for the Msc. CHDC , department of Tropical Hygiene and Public Health ,London School of Hygiene and Tropical medicine , University of London , 1980.