Dimensions: Who is to blame for the deterioration of the health insurance system?
By: Dr. Musa’ab Bereir
In the grim corridors of empty healthcare institutions, patients suffer in pain while encountering unhelpful reception staff and a lack of coverage from cold health insurance providers, if any. Whether it’s the suspension of health insurance or zakat cards, the value of the patient is diminished, multiplying their suffering. In such moments, it would have been better for the patient’s life to take priority over material calculations. However, we are living in an era of virtual health plans for emergencies.
Today, we delve into a sensitive topic, inseparable from the larger vision of health financing policies in our country. In this discussion, we focus on the partial preservation of patients’ rights, especially for those participating in health insurance. These individuals find themselves in desperate need of health insurance services due to the circumstances surrounding the aftermath of the April war. Unfortunately, the health insurance authority has turned its back on them, demonstrating a strange indifference.”
Every day, people in our grieving country diligently seek health insurance services. Unfortunately, new policies and decisions are imposed on them without proper notification. After realizing that the service is no longer free, they have to pay to see a doctor or undergo laboratory tests. The Health Insurance Authority is now imposing fees on these services, often amounting to more than 50% of the fees charged by healthcare institutions. Some states have even stopped issuing health insurance cards due to accumulated unpaid debts. As a result, the insured individuals have to resort to Wad Al-Baseer shop for their healthcare needs. However, access to treatment is severely limited, with even basic medicines like Panadol being unavailable.
In response to this situation, the leaders of the Health Insurance Authority have recently announced their intention to bring about a shift in the medical service landscape, with a focus on sustainability and quality. Dr. Farouk Nour Al-Daem Omar, the Acting Director General of the National Health Insurance Fund, has stated that the Fund’s General Administration is committed to implementing the strategies discussed during a workshop hosted by the Fund’s presidency. This workshop involved the participation of health insurance directors from various states, including Gezira, Kassala, Gedarif, East Darfur, West Darfur, Blue Nile, and Sennar. The goal of these interventions is to improve the integrated medical services, ensuring sustainability and quality.
In a statement to SUNA, the Acting Director of Health Insurance highlighted the key outcomes of the workshop. The outcomes include the importance of reviewing updated medical service packages, maximizing the utilization of free medical supplies, grants, and donations, and developing a vision for procuring medicines from abroad through mass procurement in coordination with partners. The role of medical supplies should be activated, and it is recommended to explore using banks for financing the purchase of medicines and medical consumables through simplified procedures. Additionally, the workshop emphasized the need to optimize resources, improve collection mechanisms, and promote rational use of medical services.
During the meeting, a mechanism for providing services to national ID holders who have been displaced by conflict was discussed. Furthermore, the meeting addressed the provision of psychological support services in direct facilities for those insured individuals affected by the war. Noor provided an overview of the efforts made by state branches to deliver integrated health services by reviewing and updating the service packages in accordance with the current situation, considering the limited resources available.
It is well known that there was an agreement to use the health insurance system as a reliable way to fund healthcare. Binding directives were issued, stating that the Ministry of Health or its partners in the private or voluntary sector should provide healthcare services to health insurance buyers. However, there has been no progress in implementing this policy. In fact, the Health Insurance Authority has been unable to pay its debts to service providers. Moreover, decisions have been made to charge fees for previously free services enjoyed by the insured. Additionally, the suspension of Zakat cards and interruption of medication supplies in health insurance pharmacies further highlight the lack of progress.
Continuing to rely on health insurance for providing health services is a clear violation of the strategic direction aimed at reforming the health financing system. Instead, it has resulted in the establishment of a parallel system (which has failed) that wastes the limited resources available. This persistence in failed policies has not only led to a waste of money for health insurance subscribers but has also left them searching for services that are no longer available.
We propose restructuring health insurance and changing its name to ‘health insurance fund or office.’ In order to enhance its services and reduce administrative costs, it is important that these costs do not exceed 15% of the total budget. This can be achieved by adjusting the incentives and allocations of the leaders through the oversight of the Auditor General.
Additionally, all Ministry of Health employees should be reinstated with health insurance under the Federal Ministry of Health and its branches in the states. This will strengthen the government’s ability to provide medical services. The role of health insurance should be limited to collecting contributions from the insured and purchasing services from health institutions through the Ministry of Health. It is also necessary to reduce the number of employees, administrators, and others who currently consume a large portion of the health insurance budget.
The same approach should be taken with the Zakat Bureau, which has failed to fulfill its obligations towards the poor. It is important to hold these institutions accountable and conduct thorough research to understand the real reasons behind their failure.
In summary, the institutions that were established to combat poverty have failed in their first significant test when people needed their services the most. This situation demands careful investigation to identify the root causes of this failure. The helpless Sudanese citizen is now burdened with the high cost of this failure, which has disappointed us and eroded our trust in these institutions. May God have mercy on those who suffer in this difficult situation.