Access to Health – A Public Mirage, and a Private Expense

The concept of health insurance, commonly known as medical aid in our context, is quite new to our way of life and only a few understand how it works. Being a grudge purchase it is and heavy on household’s budgets, most decide that it is an elitist product designed to defraud God’s people of their hard-earned money. Of those who enjoy this treasure, over 95% partake of it as part of the employee benefits embedded within their employment contracts and there is no choosing whether to join a medical aid or not. The remaining 5% comprises of former participants of the first group (the 95%) who due to retrenchment, retirement and resignation to pursue self-employment or other personal interests had to forfeit the employment based benefits. Because of the known benefits of medical aid, they then decide that they cannot live without medical aid. This minority group (5%) also includes the sandwich generation (the payers of heavy black tax) that decided that their parents’ health is a priority and they will fund their parents’ provision for quality healthcare from their pockets. Throwing an age-dependency ratio of 60.9% (2016) and an unemployment rate of 29.3% (2014) into the mix further complicates our dilemma as a country – fewer people are contributing to fund healthcare both private and public health.

Another perspective that might explain low take-up of medical aid in the country can be traced back to our religiousness. Convenient beliefs are normally portrayed in hyper happy churches of how God can heal. A perpetuation of an extreme belief is rising and numbs the brains of fellow humans where buying medical aid is perceived as lack of faith. Shouldn’t we also seek advice and medical know-how from his servants, the doctors? A variation of this happy gospel is the one that says, “your neighbour is bewitching you”, therefore kill a goat and your leprosy will go away! The exasperation that is brought about by these extreme dogmas is that people are dying, mostly for lack of knowledge.

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Yes, we could easily blame our fruitless politics and lack of foresight of governments, but our reality in terms of access to decent healthcare remains as gloomy in 2023 as the after-effects of Sephetho sa 1998! The recently and prematurely dismantled 18 year PPP with Netcare was clearly not serving the interests of Lesotho but was providing some comfort. At some point in 2018, the Ts’epong management announced that the hospital is filled to capacity and could no longer admit any more patients. Lesotho’s need for proper healthcare is rising at a faster rate than the rate at which government is solving our pothole of problems. While the new government is promising a Healthcare Revolution that will improve quality of health infrastructure, care and personnel, do you trust them with your health? Of course we need to take matters into our hands and run to the gym, eat healthy and stay away from the cold!

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Subscribing to a medical aid paves a way towards “aiding” government hospitals and care centres to reduce traffic and re-allocates the attention to the remaining population. As much as the “covered” population is small, the impact is huge. The few working people that have not subscribed to a medical aid are sternly increasing the dependency on government for healthcare services. The cost of healthcare funding is not a respecter of persons, it remains high whether you are government, orphan, poor or rich! Even though it is subject to abuse, the medical aid system is still the best solution to the problem. The functionality of a medical aid is based on the traditional funding model of using income received from member contributions to pay claims as well as other non-health costs that are necessary for the effective administration of the scheme. This pool of funds is given rules and restrictions to ensure the sustainability of the pool in as far as giving healthcare access to as many as members as possible. Out of pocket expenses may not suffice for a household where a bread winner is undergoing cancer or dialysis treatment, and they cannot wake up to earn a living.

This is not a theoretic exercise to educate the masses, it is a sales pitch! If you are 40 years old and you cannot tie your shoe laces or you struggle to mount three flights of stairs without suffocation, we need to talk!