Iraq announces the activation of the health insurance law to improve the medical situation.. What are the chances of its success?

After years of deteriorating health conditions and its impact on the lives of Iraqis, with a lack of health services and a lack of infrastructure, medicines and medical devices, the Ministry of Health announced - last week - the launch of the health insurance form, in a step described as a "mission" towards implementing the health insurance law.

The Iraqi parliament approved the health insurance law in October 2020, which includes 12 chapters and 44 articles, with the obligation to apply it within 6 months after its approval in February 2021 by the former President of the Republic, Barham Salih.

The country did not succeed in applying the law within the legal period, due to the crises it witnessed throughout that period with the failure to approve the general budget, and the failure to form the government for more than a year after the October 2021 elections until last October.

After the entry into force of the health insurance law and the start of the procedures for its application, many questions arise about the extent to which it can be actually applied, and about the most important advantages that the law will provide to Iraqis.

The Iraqi Minister of Health, Saleh Al-Hasnawi, announces in a press conference the launch of the electronic form for health insurance (communication sites)

Activate health insurance

And the Iraqi Minister of Health, Saleh Al-Hasnawi, announced - last week - the launch of the health insurance form in the country, saying, "The health sector is one of the government's most important programs and priorities, and that there are 5 important programs, on top of which is the implementation of the health insurance law," adding that the law aims to protect the citizen. From spending that is not possible on health services through the assistance of the state and its participation in part of the value and cost of the services that the citizen receives in the sector and the private wings of the Ministry of Health.

Al-Hasnawi stated in a press conference - attended by the Al-Jazeera Net correspondent - that "the cost of one surgical operation in the private sector may amount to 5 million Iraqi dinars (about 3450 dollars) paid by the citizen in the private hospital, but the subscriber to the health insurance and the insurance body will pay a rate not exceeding 25% of the cost." The value of the operation, and that the government - through the guarantee fund - will guarantee 75% of the value of the operation, which is happening for the first time in the country.

And regarding those covered by the law, it is expected that its provisions will apply to Iraqis and foreigners residing inside the country, given that the law guaranteed this through compulsory participation in health insurance through insurance companies licensed and accredited by the Insurance Authority concerned with the application of the law, while the minister indicated that “there are protected groups.” In full, including those covered by the social care network, as the Health Insurance Fund - which represents the Iraqi government - will take care of all medical services.

The health insurance law will cover the largest proportion of medical care costs for Iraqis covered by the law (Reuters)

Health insurance application mechanism

Al-Hasnawi added that the government is determined to implement the law, as his ministry will start this year by launching the electronic form for registration on health insurance, and that between 250-300 thousand citizens will be registered this year, indicating that the current year will be for trial operation, and that the employee who participates at a rate of 1% From his monthly salary, he will be covered by the guarantee, in addition to his wife and children (under 18 years old) and his parents who are not employees, he said.

For more details, a spokesman for the Health Insurance Authority, Ihab Abdel-Karim Khalaf, explained - in his interview with Al-Jazeera Net - that the law will be implemented gradually, and that the first target group will be the capital, Baghdad exclusively, indicating that certain bodies have been identified from the three presidencies and ministries to be included at the beginning of the application. The law, in addition to about 100,000 people covered by the social welfare network.

For her part, a member of the Health Committee in the Iraqi Parliament, Asmaa Al-Ani, explained the most important provisions of the law and the stages of its implementation by saying, “The procedures were divided into 3 stages, as the mandatory stage includes all state employees, while it will be optional for retirees and the rest of society, as those covered by the guarantee will be given a special card for that.” And that medical services will be provided after 6 months have passed from the date of registration.

Speaking to Al-Jazeera Net, Al-Ani explained that this will take place in conjunction with the conversion of health institutions to work with the unified accounting system, with an increase in the number of doctors in the field of family medicine and the work of the referral system, pointing out that the third stage will include all Iraqis in the Health Insurance Authority with their obtaining the insurance card, according to saying it.

Cost and categories covered

With regard to subscription fees, Al-Ani indicated that they will be between 10-50 thousand dinars, equivalent to ($7-32) per month, depending on the employee's job grade, and the monthly installment will not exceed 1% of the employee's total salary, and that there are many categories. Those who will be exempted from paying the monthly subscription, such as those covered by the social welfare system and some people with chronic diseases.

In the context, a member of the media team of the Ministry of Health, Ruba Falah, said - in contact with Al-Jazeera Net - that the groups exempt from paying the monthly subscription are those covered by the social care system, and those with cancer, mental illness, genetic blood diseases, kidney disability, physical and mental disability, and autism, in addition to the handicapped. All categories of the security forces, males who are not employees, as well as retirees over the age of 60, females who are not employees and retirees over the age of 50, in addition to children under the age of five.

The head of the Iraqi Doctors Syndicate, Jassem Al-Azzawi, believes that there are obstacles to the health insurance law, and they must be addressed (Al-Jazeera)

Regarding the implementation of the law, the head of the Iraqi Doctors Syndicate, Jassim Al-Azzawi, explained that it will start after completing the guarantee institutions, data and electronic supplies, as citizens will be provided with an electronic card used in guarantee clinics within specific controls, pointing out the possibility of those covered by the health card reviewing health insurance clinics, and that some of these clinics It will belong to the public sector and some to the private sector, with equal medical capabilities between the two sectors, which applies to laboratories and pharmacies, he said.

Challenges and difficulties

Despite the foregoing, Al-Azzawi - in his speech to Al-Jazeera Net - does not hide the existence of real difficulties and challenges that impede the implementation of the law and its implementation, indicating the need for medical and media education efforts in the law, and that the government must prepare the requirements of the law and its participation in the necessary financing, indicating that implementation will be in 3 stages. or procedures;

Pointing out that the first phase began a few days ago, and that all procedures will be completed within 5 years, according to him.

Asmaa Al-Ani agrees with this opinion, adding that "among the challenges that will face the implementation of the law are the weak databases of the target groups, as well as the weakness of electronic governance and determining the size of the excluded groups, the size of the expected financial gap at the beginning of the implementation of the law and the weakness of the accreditation system, in accordance with international standards for the work of health institutions." Government and the private sector, the volume of activity and control over the payment mechanism in the public and private sectors.

Member of the Parliamentary Health Committee, Asmaa Al-Ani, confirms that one of the advantages of the law is reducing treatment costs for patients (Al-Jazeera)

Health insurance benefits

With regard to the benefits that will be provided by the health insurance law, Al-Ani indicated that it provides comprehensive health coverage for the participants in the law while achieving the principle of justice and social solidarity, as well as reducing the financial burdens on the citizen and reducing poverty, and the multiplicity of sources of private sector financing and the creation of a good environment for competition.

She added that the law will contribute to developing the performance of workers and health institutions in the public and private sectors, while improving the quality of medical services provided by regulating work in the health sector and competition in providing medical services, and encouraging the private sector to invest in the field of health services.

As for the reasons for the law, she indicated that it is represented by the lack of health system financing resources and the lack of qualified human resources, as well as the problems of insufficient infrastructure in hospitals and health care centers, and the lack of health services that are compatible with the patients’ needs, pointing out that the law will ensure Reducing health care costs borne by the Iraqi patient.