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Writer's pictureAfya Bora Afrika

RETHINKING HEALTH INSURANCE BY OFFERING PATIENTS MEMBERSHIP PLANS

The cost of treatment is the main reason people avoid health care services in Africa. Health care is very expensive and unaffordable to many Africans. Many Africans are not insured, and the few who are insured, don’t get the services they need promptly and adequately due to late approvals and unexplained delays in getting claims paid. Lack of trust in insurance service providers, and poor services delivery, have also contributed to the low number of health-insured people in society.


Are you a member of a sports club or a visitor? Which one is expensive? Normally, the charges on sports clubs are more expensive on visitors than members. Primary Care membership plans can be used to fill the gap with health insurance services, reduce deductibles and out-of-pocket expenses from patients, and also provide the ability for health providers to spend more time with patients and give more personalized and thorough care.

Offering a membership plan that looks much like an insurance policy is a better way to insuring those who lack specialize care insurance plans such as skin, dental, eye, etc., and those who rely on out-of-pocket payment. Membership plans cut out-of-pocket payments for patient care services according to the plan, while guaranteeing exclusive services such as free examinations, checkups, exclusive emergency care, and discount specialize procedures that might be expensive or not insurable.


Membership plans are better than insurance plans because they don’t have to deal with insurers’ heavily discounted reimbursement rates, wait to get preapprovals to provide services and there are no delays in getting claims paid. By cutting out the middleman, patients on membership plans act like insured patients, and come in as much as insured patients, but pay less for coverage, while health providers also get paid more.

Private health insurance covers are expensive, especially if you are unemployed, self-employed or your company does not offer a health insurance cover. Patients who are self-employed or work for small businesses joining the practice’s membership plan can be cheaper, more affordable, and guaranteed care.


For patients without a job-based health insurance plan, purchasing an independent eye, skin, or dental policy exclusively is very expensive and unaffordable to the majority of the population. Membership plans are less expensive than when paying strictly out-of-pocket, and prepaying for services motivates the person to seek preventive services. A membership plan keeps one on track since it is like having a down payment on your care.


HEALTH NEWS AFRICA

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