BY Hazim Rahahleh
There have been many missed opportunities to establish a socialhealth insurance system that ensures access to medical care for those who need it,while remaining affordable. The idea of social health insurance, like all other types of social security, is founded on economic and social concepts such as mandatory saving for unexpected costs and risks, and solidarity between members of the same generation and among different generations; young people protecting the elderly(most vulnerable to diseases), those who are well sharing costs with those who are ill, and high earners supporting those with lower incomes.
We cannot overlook the fact that more than one third of Jordanians are not covered by any health insurance, leaving them vulnerable to poverty and destitution if they experience any adverse health circumstances. In such a case, available options for getting appropriate treatment are limited, not guaranteed and are inherently unsustainable. The absences of health insurance has a negative implications on individuals as well as on health spending efficiency. Direct spending on healthcare by individuals is shrouded in many problems, and among the most prominent of these include weak control of medical procedures and denial of strategic purchasing power.
Jordan has made great strides in institutionalising the social security system and expanding its reach, and Jordan’s experience in social protection is aligned with international standards, and has achieved global distinction and recognition as one of the best models worldwide. The repercussions and challenges of the COVID-19 pandemic have been a real test of Jordan’s social protection system and the experience of the Social Security Corporation. Nonetheless, today these systems agility and high level of responsiveness by providing exceptional and timely interventions and measures while protecting the financial sustainability of the corporation. Such acknowledgement constitutes a testament to their sustainability and inspires confidence.
The COVID-19 pandemic did not dissuade the government from planning and preparing for a national social security system, which is a strategic direction that it has remained committed to and has managed to achieve all its strategic milestones set for the past three years. Now, the only remaining barrier preventing the completion of the social protection system is the lack of a national health insurance system. This component has received significant government support and witnessed exceptional coordination with the Ministry of Health and all other parties involved in the sector.
Gradualism: the most realistic and safe approach
The corporation’s experience in expanding the social protection system has shown that a gradual roll-out is the most appropriate and safest model for implementation, and for the health insurance in particular. It is a complex endeavour that will benefit from the wisdom of experience and prioritisation of key areas. Therefore, the corporation has embarked on a health insurance project to focus on the most expensive aspect of healthcare–in patient services- which incurs high financial costs for patients and may prevent them from receiving appropriate care.
The prioritisation approach requires us to focus on the categories that are not currently covered by any health insurance plan. Since the corporation is mainly concerned with employees and retirees, these categories will be the basis for the launch of the health insurance, which will ensure that they and their families receive medical care at private and public sector hospitals that meet various accreditation and quality requirements to provide distinguished healthcare and services. Any private sector worker who is not provided with health insurance by his or her employer will be covered, as will retirees who are not covered by any other insurance.
The corporation will leverage its strong negotiating position as a diverse service provider with a wide umbrella of services to offer outpatient treatmentsat discounted prices through various Ministry of Health primary care centres,private health centres and clinics.
Proposed health insurance: Will it be limited to workers and retirees?
The corporation has stressed, on more than one occasion,the need for covering not only the individual worker, but their immediate family members, spouse, and children with social security health insurance. Today, this demographic includes more than 1 million people who will require coverage under basic health insurance to access free treatment within an approved medical network in addition to preferable price advantages for outpatient treatment. Providing insurance for approximately 2 million Jordanians will guarantee if — God forbid — they are diagnosed with cancer, they will have the opportunity to receive cancer treatment at a world class centre — the King Hussein Cancer Centre. Insurance will protect families from the high financial costs associated with hospitalisation if any of their members require it. In addition, interventions to deal with heart, neurological and brain diseases, births, and many other cases will be fully covered by insurance.
Social Security Plan: Dispersing or complementing the health insurance system?
The proposed insurance programme is not a source of fragmentation in respect of national efforts to provide integrated healthcare services. The introduction of a new umbrella for health insurance will add a new player to the health care system, along with government health insurance and private health insurance, which covers around 10 per cent of Jordanians under its umbrella. But the central question is whether existing insurance plans have the ability to accommodate all groups in a way that achieves justice,improve permanence, and ensures appropriate care? Experience over the past several years and decades has shown us that the current state of insurance coverage when compared its aspirations is not hopeful. As such, it is necessary to distinguish between what is perfect and impossible and what is imperfect and possible, and inevitably the most rational option is to move towards the possible.
In this context, the experience of social security for old age or “retirement” insurance may be cited. Such insurance has been seen in the context of dispersion of social protection system; thecivil pension and military retirement systems were in place, and there were also companies that provide life insurance windows, just like the case with the health insurance system today.
In fact, the same experience has proven that the unification of any social protection system requires an “Anchor Player” with institutional and insurance capabilities to serve as a lever. Within the social security context for retirement insurance, none of the public and private systems that were in place at the time were able to shapea cohesive and sustainable framework. If we accept the concept of dispersion and scattering, hundreds of thousands of Jordanians will end up without pensions.
On the contrary, after the social security system proved its durability and usefulness, it became — albeit gradually — the umbrella for all workers in the private and public sectors, both civil and military, albeit gradually, and this over time will also fall on health insurance.Perhaps the distraction lies in working towards a comprehensive model that is idealistic, but unrealistic and scattered. Such a model could not be applied successfully even in countries with a long history of health insurance systems.
Health insurance is not only a pillar of social protection but also provides new space for investment
Global experience confirms that a sustainable institutional umbrella for health insurancewhich relies heavily on the capabilities of the private sector provides additional space for investment and spending in the health sector. The volume of annual spending on insurance will exceed a quarter of a billion Jordanian dinars during the first five years and is expected to reach about half a billion dinars after ten years. Insurance will help exploit underutilised capacity in the private sector and will motivate investors in the sector to expand capacity over time. This is in addition to increasing the effectiveness of ongoing spending on healthcare and motivating all hospitals, including public ones, to improve their level of performance as the accreditation of therapeutic medical bodies will be based on clear criteria related to performance, service delivery and quality.
The ability of insurance to open up new investment horizons will also coincide withimproved opportunities for employment. The absence of health insurance has always been an obstacle preventing the motivation of young Jordanians from engaging in the private sector, and inhibits the progress of Jordanian competencies.
Health insurance will be independent of the rest of the corporation’s insurance
Perhaps the main concern surrounding the activation of health insurance under social security is that it can negatively affect the financial sustainability of the corporation. Of course, this is a legitimate concern, as social security has become a title of protection and living stability. This is why we want to emphasise that the health insurance will be independent and separate fromother insurances such as unemployment insurance. Most importantly, its revenues and expenses will not interfere with the rest of the insurances. The programme was designed after a series of consultations and studies which carefully considered its cash flows with a high level of certainty.
Perhaps the most important reminder is not fall prey to exaggerated obsessions and stereotypical impressions. Just as we have to be wary of the failures surrounding the implementation of insurance in a number of countries, we must also cite successful experiences. Hardly any kind of promising national project is without its own challenges and obstacles, but they should always be undertaken with the hope and real possibility of overcoming them.
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