GERMANY has the world’s oldest national health insurance scheme, with origins dating back to Otto Von Bismarck’s Sickness Insurance Law of 1883.
Britain created the National Health Service in 1948, funded out of general taxation rather than on an insurance basis and providing health services to all legal residents.
In essence, national health insurance programmes differ both in how contributions are collected and in how services are provided.
In countries such as Canada, payment is made by the government directly from tax revenue and this is known as single-payer healthcare.
In France, a similar system of compulsory contribution is in place, but the collection is administered by non-profit organisations set up for the purpose.
The national health insurance scheme seeks to ensure that health services are accessible to all citizens in line with section 76 of the Constitution, which stipulates that every citizen and permanent resident of Zimbabwe has the right to access basic healthcare services.
A functional national health insurance aims to provide healthcare coverage for all citizens, ensuring that individuals and families have access to necessary medical services, regardless of their income level and socio-economic status.
Financial protection of individuals is offered by reducing out-of-pocket expenses for healthcare services.
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Health and Child Care minister Douglas Mombeshora recently announced that a national health insurance will be operational beginning mid-2026.
There are many sources of funds, but in varying degrees: private, employer-employee contributions and national taxes.
The government of Zimbabwe is likely going to consider earmarked taxes that are considered win-win health taxes that aim to reduce consumption of unhealthy products while generating the much-needed revenue.
Such health taxes have key principles of simplicity, predictability and protection against industry interference.
Behavioural determinants of health include smoking, alcohol intake, dietary control and it is no secret that our government should consider introducing earmarked taxes on tobacco use, alcohol consumption, fat intake.
It should not surprise anyone if taxes such as tobacco tax, alcohol tax, fat tax are introduced if really we are serious about succeeding in establishing national health insurance.
The health levy on airtime has been in existence since January 2017 and is ring-fenced for health facilities only.
It is supposed to be used to purchase drugs and medical products.
The Aids levy was introduced in 1999 to fund the national response to the HIV and Aids pandemic.
The sugar levy was introduced in 2024 in order to discourage excessive sugar consumption and raise revenue for cancer treatment.
Imagine all the public health issues attributed to alcohol.
Cancers, pancreatitis, road traffic accidents, domestic violence, assault, murder can arise as a result of alcoholism.
Imagine the effects of smoking on public health.
The success of the national health scheme will be a milestone in health service delivery.
The national health insurance will provide access to healthcare for all citizens, including the majority who currently lack medical aid cover.
Close to 90% of Zimbabweans are not on medical aid cover, meaning lack of financial protection for the masses who are forced to rely on out-of-pocket payments.
What the national health insurance will aim to do is to strengthen primary healthcare, then offer scaled benefits at higher levels of care.
Primary healthcare provides health services as close as possible to where people live and work, focusing on health promotion, disease prevention, treatment and rehabilitation.
It is often the first point of contact with health service and includes services from general practitioners, community pharmacies and allied health professionals.
The administration of national health insurance funds is a critical determinant of the success of the schemes.
I foresee the Health and Child Care ministry being the custodian of the national health insurance in the country although it may be worthwhile to have the funds administered by a private organisation or selected non-profit organisations in the country.
Allowing government to administer such funds may not be the best option as many people believe that government may be overwhelmed with issues.
Premier Service Medical Aid Society is limping today yet government has been the biggest contributor of funds to the society.
Corruption should never be allowed to germinate, proliferate or mature in national health insurance schemes.
Many people will be able to access medical services in the country with the decongestion of the public health system as contracted private practitioners will offer healthcare to any citizen, with funds coming from the national pool.
Healthy people pay for the sick through national contributions, but the end result is universal health coverage in the country.
Sound execution of national health insurance will bring tangible health results.
