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A new health insurance program which was ratified by the House of People’s Representatives last year should take effect this July. The new scheme will include organizations which already provide health insurance to their employees.
Divided between social and community based health insurance, the program was studied for two years before its decision for implementation.
The Ministry of Health (MoH) will oversee the program through a sub-agency established last year. Now any permanent employee of a private, governmental, or nongovernmental organization must contribute three percent of their total salary, along with their employers to go into the new health insurance program.
Although no official announcement has yet been made, sources at MoH believe that the insurance will become effective in July, the first month of the new budget year.
All organizations, even those who already provide health insurance for their staff families are affected by this new program. Although companies have the option of providing another type of health insurance they also must participate in this program.
Companies with less than ten employees are exempt from the program. The mandate is effective throughout the nation. Based on the regulation, family members of the health insurance payers are also included in the coverage.
Health care will be provided by public health facilities. According to the law, patients can go to specified medical service providers including hospitals and clinics for most medical treatment and the agency will compensate the institution within ten days. The Agency is completely responsible for settling the bill on time.
People who have community based health insurance plans or people that are not registered as taxpayers such as farmers can choose whether they want to receive the service or not. People who are unemployed are also eligible for the community based health insurance program. Already a pilot program is being implemented in three weredas of Amhara, SNNP and Tigray regional states and four weredas of Oromia.
“Initially public health facilities will be providing the treatment but in the future private health centers can participate if they can provide services at competitive rates,” Assefa Ayde, public relations officer of MoH told Capital.
He said that this healthcare program will allow more people to have access to treatment because public hospitals will not need to rely on the support of donors and governmental subsidies.
“When public heath becomes stronger financially, the service in public healthcare facilities will improve because we will be able to retain highly trained professional staff, give better medication and provide other services,” Assefa added.
“The new scheme will also encourage the public to go to health facilities for treatment and demand quality treatment in public institutions,” he added. The public relations officer said that the main focus of the scheme is solidarity and improving the public’s health.
According to the new scheme the agency will be organized by weradas to implement the health program.
Plastic surgery, dental treatment, dialysis and medical treatment performed abroad are some things that will not be covered by the insurance.
According to Assefa, antenatal cases, TB and anti retroviral treatment (ART) will continue to be provided for free at public hospitals.
The health insurance program is being financed by USAID’s Health Care Financing Project under the oversight of the MoH. Other ministry directorates contributed to the study.