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Private Health Insurance and Universal Health Coverage

The Nairobi West Hospital entrance: The health facility has been receiving negative public feedback

The bottom-line of attaining UHC is to bring life-saving health care interventions and interceptions to those who need it most when needed, irrespective of their economic status.

Private health insurers for the longest have offered health coverage for those who can afford it, obviously leaving out the poor or those, who on their own cannot afford to buy insurance. In fact, their targets have mainly been the employed through corporate covers or the middle- and upper-income individuals. Rarely have they had covers for the lower sector of the society, apart from the recent years where various groups have come together to contribute towards goals and have made health insurance one of the benefits and the private insurers have accepted such groups – Women, youth, men and special needs groups.

The question then begs, how does the private insurance sector fit into universal cover for all especially in countries that either have or are rolling out affordable public social insurance? Will their current model work to maintain their clients and bring on board new ones or is it an end to an industry that has been perceived to favour the haves above the half nots?

According to Jayesh Saini, he sees the private insurance industry adjusting in some ways to embrace universal health coverage across nations. In Africa, especially due to the state of health industry in general, the private and public must work together to bring a lasting solution to the endemic problem of lack of accessibility to services due to limited financial capacity, at the personal, household, and national level. He believes that the private insurance firms would play a very important role in complementing what the governments are doing.

Jayesh believes that if governments came up with minimum packages that would ensure that the all populace have access to primary healthcare that would see them have doctor’s consultation, some diagnostics, laboratory and pharmacy services for all the common conditions, the health problem would be greatly solved. The private insurer would then come on board and offer supplementary services that would compliment the governments’ packages for those who feel they want something extra – such as access to high-end private facilities or private wings of government facilities.

He believes that private insurers play a very important role and should not be phased out through policies and laws that would limit their performance, destroy their resource base and push them to very high premiums that would not be attractive. The industry has employed hundreds of thousands of people and therefore a great source of revenue through taxation for the government.

Besides that, private insurance has other benefits that it provides, such as workman’s compensation, injury on duty, last life expenses among others that the national programs do not offer and yet are very important. The governments should work with the private insurances to ensure that through their programs these services are provided for, amongst all the national client base. UHC is supposed to help Tom by getting something from Peter and not killing Peter to feed Tom, and that is the way it really will work in any nation.