‘Doctor, how are we going to pay for this?’

 

From Medical Crisis to Financial Security: Why insurance matters

COMMENT | JOAN NANKYA | For more than six years, my daily work has centred on medical insurance, reviewing claims, managing provider networks, and developing solutions that protect individuals and families from the financial burden of illness.

Yet the most memorable part of this work has never been the numbers. It has been the conversations. The calls that stay with me are not from corporate clients discussing policy renewals.

They are from distressed families standing at hospital reception desks, desperately trying to secure emergency treatment for a loved one while scrambling to raise the cash deposit required before care can begin.

Those moments reveal an uncomfortable reality about healthcare in Uganda: illness is often not only a medical emergency but also a financial one.

When someone falls seriously ill, the first question many families ask is not, ‘Which doctor should we see?’ It is, ‘How are we going to pay for this?’. This is more than an individual hardship; it is a national challenge.

According to the World Health Organization and Uganda’s Ministry of Health, out-of-pocket payments account for roughly one-third of Uganda’s current health expenditure. In practical terms, millions of Ugandans pay directly for healthcare at the point of service, exposing households to financial hardship whenever serious illness strikes.

A severe malaria infection, complications during childbirth, emergency surgery after a road traffic accident, or the long-term management of chronic conditions such as diabetes and hypertension can erase years of savings within days.

Beyond medical bills, families often face lost income, interrupted education, and difficult decisions about selling assets simply to afford treatment. For generations, Ugandans have relied on informal support systems to cope with these situations. Savings groups, family contributions, community fundraisers, WhatsApp appeals, and emergency loans have become familiar responses whenever illness strikes.

These acts of solidarity reflect the strength of our communities, but they are reactive. They help after financial damage has already occurred rather than preventing it. Medical insurance offers a different approach. Unfortunately, insurance is still widely misunderstood. Many people associate it with large corporations or view it as an unnecessary expense if they remain healthy throughout the year.

This perception overlooks the very purpose of insurance. Insurance is not an investment designed to generate financial returns. It is a financial protection mechanism that transfers unpredictable, potentially devastating healthcare costs into affordable, predictable contributions.

By pooling premiums from many people, insurers create a shared fund that covers the high medical costs incurred by those who need expensive treatment. In simple terms, buying medical insurance is not expecting to fall sick. It is ensuring that if illness comes, it does not become a financial catastrophe.

The value of insurance extends beyond paying hospital bills. When healthcare depends entirely on cash, many people delay seeking medical attention because consultation fees, diagnostic tests, or medicines appear unaffordable.

Conditions that could have been treated early are allowed to worsen. By the time patients finally seek care, illnesses are often more advanced, treatment is more expensive, and outcomes are less favourable. Medical insurance changes this behaviour by reducing the immediate financial barrier to care.

It makes it easier for people to seek medical advice earlier, leading to timely diagnosis, appropriate treatment, and better health outcomes. Early intervention not only improves recovery but also reduces the overall cost of treatment for families and the healthcare system alike. Insurance also creates value in ways many policyholders never see.

Medical insurers negotiate treatment costs with healthcare providers, maintain quality standards across provider networks, review claims to reduce unnecessary expenditure, and help ensure patients receive appropriate care.

Individual patients rarely have the bargaining power or technical expertise to achieve these outcomes on their own. Encouragingly, Uganda’s insurance market has evolved considerably over the past decade.

What was once largely limited to employer-sponsored schemes now includes affordable retail products, family packages, and solutions designed for small businesses and workers in the informal sector. Medical insurance is gradually becoming more accessible to ordinary Ugandans.

At the same time, the country’s efforts to establish a National Health Insurance Scheme reflect growing recognition that sustainable healthcare financing depends on risk pooling rather than excessive reliance on out-of-pocket spending. While this reform remains an important milestone, households need not wait for its full implementation. Practical insurance solutions already exist and can provide meaningful financial protection today. Improving insurance coverage, however, requires more than making products available. It also demands greater public understanding of how insurance works and why it matters.

Too often, people judge the value of insurance by whether they make a claim during the policy year. Yet the real value lies in knowing that should a medical emergency occur, treatment can begin without first finding money, selling property, or organising emergency fundraisers. That peace of mind is difficult to measure but invaluable when families face some of life’s most uncertain moments.

The conversation, therefore, needs to change. Instead of asking whether medical insurance is worth paying for, we should ask whether we can afford to face a medical emergency without it. After more than six years of working in medical insurance and witnessing the stories behind countless claims, one conclusion stands above all others: medical insurance does far more than settle hospital bills.

It protects livelihoods, preserves family assets, enables timely access to quality healthcare, and allows families to focus on recovery rather than financial survival. As Uganda continues its journey towards greater financial inclusion and universal health coverage, medical insurance should no longer be viewed as a luxury for a privileged few.

It is an essential pillar of financial resilience, healthier families, and stronger communities. Investing in health is ultimately an investment in economic security, and medical insurance remains one of the most practical tools available to help households withstand life’s inevitable uncertainties.

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The writer is the Head of Medical Business at ICEA LION Uganda