Center for Health Market Innovations (CHMI)

Programs

Ishaka Hospital Health Insurance Scheme

last updated Feb 6, 2012

Overview

Implementing organization: 
Ishaka Hospital
Implementation Partner(s): 
Ministry of Health
Legal Status: 
Private (not-for-profit)
Year Launched: 
1999
Income Level of Target Population: 
Bottom 20%, 20-60% (lower to lower-middle)

Funding

Primary Source of Funding: 
Membership/subscription fees
Additional Source(s) of Funding: 
Donor
Funders: 
Ishaka Adventist Hospital, UCBHFA

Scale

Number of Clients Served: 
A population of approximately 314,692 people
Summary: 

This insurance scheme is open to the poor population, families who are already members of established groups such as burial societies, dairy cooperatives, employers/employees groups, school teachers, students, and hospital contract workers among others.

Program goals/rationale: 

The objective of the scheme is to promote good health in the communities and qualitative and affordable health care services, reduce death rates in the community, reduce hospital debts, and to eventually open clinics in the rural areas so as to bring health services near to people.

It also intends providing coverage for a more comprehensive postnatal care since women join the scheme because the hospital provides better health care services than the government or other private clinics and nursing/maternity homes.

Key program components: 

Ishaka Hospital Health Insurance Scheme was designed to cover mainly acute infectious diseases like malaria, respiratory and urinary tract infections, and gastrointestinal infections excluding chronic diseases such as diabetes and hypertension, and neither for normal delivery because it was thought that there would be too many normal deliveries to be covered; and hence, it would be too costly. In addition, the Ministry of Health had recommended that maternity care should not be covered by the health plan. However, in the face of popular demand from the communities, cover for normal deliveries and deliveries with complications were initiated and later Ishaka Hospital branded a new maternity ward, which was funded by ADRA. It is equipped with an operating theater for caesarean section, an incubator and an ultrasound machine.

A family of 2-4 members pays the minimum premium of 15000 Ugshs and any additional family member pays 3700 Ugshs to cover a period of 3 months.

The health scheme benefit package includes health education/ prevention care; HIV/AIDS care where a member who has HIV/AIDS or is just HIV sero-positive is covered for only malaria; Prenatal care: which covers routine antenatal check-ups by midwives, medicines, referrals and treatment for pregnancy showing dangerous symptoms, major complications and sexually transmitted diseases; Delivery care: which covers hospital care, normal delivery and delivery with complications being handled by qualified medical personnel; Postnatal care: medicines and some multivitamins and iron tablets.

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