Despite being one of the poorest countries in the world, Malawians are subjected to exorbitant fees and charges when accessing medical facilities through health insurance providers, a latest global health research shows.

Reacting to the findings, health economists, consumer and health rights activists have described the development as worrying, saying it makes an ordinary person fail to be covered by health insurance.

The activists have since asked government and other stakeholders to take the report seriously

 to save vulnerable people from financial squeeze while accessing medical attention.

Patients and guardians in
a public hospital

According to the research conducted by William Russell, a United Kingdom (UK)-based international health insurance firm, Malawi has the most expensive health insurance claims in Africa and is the sixth highest globally.

The study analysed international health insurance claims data for the year 2021 to expose the most expensive countries in terms of health insurance claims and the associated types of claims that make it expensive for citizens once they get sick or injured.

In Africa, Seychelles comes second to Malawi while Zambia is third in Africa and 21st in the world. Other African countries topping the list include South Africa (fourth in Africa and 22nd globally), Zimbabwe fifth on the continent and 29 in the world. Tanzania, Mozambique and Botswana come sixth, seventh and eighth on the continent, respectively.

Globally, Denmark has the most expensive seconded by Taiwan while Qatar is third. Malawi stands just above Switzerland with Lebanon occupying the fourth position. The William Russell firm currently covers members in 160 countries around the world.

According to the research, the most common claim in Malawi is for general practitioner (GP) and specialist consultations with normal pregnancy being the most common illness while pneumonia is the illness with the highest average claim value.

The research sampled 60 claims that health insurance providers made to health facilities and the total amount claimed was around $122 876, translating into around K123 million compared to neighbouring countries, Zambia, with $68 773 (around K69 million) for the same ailments.

Health Funders Association of Malawi (Hfam) president Elsie Munthali in an interview confessed the medical care tariffs could indeed be high in the country due to various factors.

Hfam is a grouping of communal medical aid schemes such as Medical Aid Society of Malawi, Horizon Health Limited and Medhealth as well as in-house medical scheme providers such as Malawi Revenue Authority and Electricity Supply Commission of Malawi.

She said: “The charges for treatments in large and middle scale private institutions including government private wings tend to be unsustainable to medical schemes.”

Consumers Association of Malawi executive director John Kapito also admitted the health insurance claims in the country were among the most expensive across the globe hindering ordinary persons to be covered.

He observed that the health insurance firms were now surviving on high premiums instead of higher volume which could have helped them grow, as is the case in other countries.

“They merely survive on a limited number of clients with very exorbitant premiums. Unfortunately again, most firms have displayed an element of mistrust and that has also made most people remain out of the system.

“Sometimes one suspects that some level of collusion and underhand dealings among the insurance companies,” Kapito claimed.

He also condemned the quality of medical care people get from health insurance covers, describing it as “too bad compared to the premiums people pay.”

“Quality is dependent on competition and in Malawi, unfortunately, there are very few health insurance providers which are not even anywhere near what is expected in terms of quality service.

“One pays a lot of money but the standards of service delivery are very poor. That is why those on medical aid once they retire or resign from their jobs just fall away because it’s a waste of money,” said Kapito.

On his part, Health and Rights Education Programme executive director Maziko Matemba said the research should be a wake-up call for government to start seriously working on finding a way to address the challenges revealed.

He observed that the health insurance market was still immature resulting in lack of transparency and dubious health insurance claims.

“There is lack of transparency and accountability within the sector with no proper regulations and such malpractices put the lives of vulnerable patients who are in need of quality healthcare at risk because they cannot sustain the insurance.

“So this research can help to shape the policy direction and discussion around health insurance in the country. Further, the report has to be taken seriously if as a country we are to achieve the Universal Health Coverage (UHC) which, among others, states that no one should suffer financial hardship while seeking healthcare,” Matemba said.

Matemba said the other challenge was lack of public health insurance cover which makes the private health practitioners to flourish and take advantage of the market.

Ministry of Health spokesperson Adrian Chikumbe said although the ministry has not officially received the research, they know the high premiums are as a result of the thin customer base.

“If they had a wider customer base automatically that would make the premiums come to a reasonable level like it is in other countries where a lot of people subscribe to medical insurance policies and their premiums are quite manageable.

“So in Malawi, we have a very thin customer base because of, perhaps, low literacy levels in that not many people appreciate the benefits of health insurance but again the low income status, which even if one were to know the benefits, most of them could still not afford,” he said.

As one of the strategies aimed at achieving the UHC by 2030, Malawi has started implementing health insurance schemes to improve access to healthcare, according to a paper titled ‘Uptake of health insurance in Malawi in 2019-2020: Evidence from the Multiple Indicator Cluster Survey’ authored by a number of health experts.

The UHC aims to ensure that everyone has access to high-quality healthcare services that they need, without the risk of financial ruin or impoverishment

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