Ethiopia moves closer to universal health coverage

By Groum Abate

The House of People’s Representatives unanimously ratified a Social Health Insurance scheme that enables all the working society to get a health insurance.
The law would come in to effect one year after being published on the Federal Negarit Gazette.

The program will be run by an agency set up to control the insurance. Premiums will be calculated according to the income of members. They will range from a minimum of three percent of the employee to a maximum rate to be negotiated between employee and employer. Employees with contractual agreements of three months or longer would be included in the insurancepolicy .

The health insurance is classified into two types: social health insurance and community based health insurance. Social health insurance caters to all employees in the country who are on the payroll of private and public institutions. It will be mandatory for taxpayers to take out the insurance. The costs will be covered by funds collected from individuals, employers and government subsidies.

Community based health insurance deals with people that are not registered as taxpayers, which often includes farmers. These people can choose whether they want to receive the service or not.

Dependants of employees will be able to benefit from the social health insurance. People who are unemployed will be able to get placed in the community based health insurance program.

Police forces and some private company employees that do have health coverage from their employers will be controlled by the new agency expected to be set up in the coming few months.

According to the law, patients could go to specified medical service providers, a hospital or a clinic, and the agency and the patient would each pay a portion of the medical bill, as contracted. This scheme would only apply for people being treated outside the health facilities.

Outpatients would pay a minimum of 10 percent of the total payment. This is done to minimise abuse of the insurance scheme. However, patients being admitted to hospitals will not pay anything as they are admitted to the hospital on the referral of a doctor, eliminating opportunities for abuse.

Employers and employees would each deposit monthly payments to the agency. Furthermore, pensioners will be assisted by a government fund to secure their health insurance. Plastic surgery, teeth problems, dialysis and abroad medical treatment are among the identified treatments that are not going to be covered by the insurance.

CapitalEthiopia