Microcare in financial crisis

Microcare, Uganda’s biggest health insurance company, has been struck off the list of licensed insurance companies. The company, that covers 70,000 people in a network of 157 health facilities across the country, is facing a financial crisis, in which over a dozen health service providers are demanding over sh2bn in unpaid bills.

The health providers on Wednesday filed a case in the High Court, seeking to wind up the company.

In a public announcement on February 27, 2009, the Uganda Insurance Commission drew a list of authorised insurance companies and warned the public against dealing with unlicensed insurers, insurance brokers, agents, loss adjusters, assessors and insurance surveyors.

The commission listed five life insurance companies, 18 life insurance brokers as well as 19 non-life insurance companies, non-life insurance brokers. Microcare Insurance Limited never featured on any of the lists.

The Commission’s acting boss, Evelyn Nkalubo-Muwemba, said Microcare, incorporated in Uganda in June 2004, had failed to meet some licensing requirements. “But as soon as the company meets this, we will licence it,” she said.

For a company to be licensed, Nkalubo-Muwemba explained, it should have met criteria such as the sh1b security deposit with Bank of Uganda, sh2.5b in case of reinsurance business, approval by the insurance association, the COMESA yellow card requirement, authorised share capital and paid up share capital.

Microcare however insisted that they have complied with all the Commission’s requirements for the renewal of their license.

“The Uganda Insurance Commission has not revoked or stopped Microcare from transacting insurance business,” said the marketing manager, Clare Tumwesigye.

“It should be noted that it is normal for a company not to be advertised if the regulatory body is still pursing some administrative processes. We are in touch with the commission regarding our license of 2009 and would not like to divulge the details of our discussions but you are free to inquire from it (the commission) if we have been stopped from transacting insurance business,” she added.

Tumwesigye dismissed allegations that they owe health service providers billions of shillings.

She said: “Microcare handles volumes of data processed every day and this is bound to cause friction some times, which leads to reconciliation meetings of accounts, which is what we are doing with some clinics. We do not want to discuss our service providers’ business in the press.

Investigations by Saturday Vision however revealed that some of the health service providers have suspended their services to patients under the Microcare health insurance scheme. Some of the clinics have also either taken legal action or are planning to do so to recover the money the health insurance owes them.

The first client to drag Microcare to court was Kadic Hospital in Bukoto, for non payment of up to sh150m, allegedly accumulated over three years. Microcare has since paid sh60m, leaving a balance of sh90m. The company also owes Case Clinic, sh700m, Paragon Hospital, sh770m, Mulago Hospital private wing, sh180m and Kampala Family clinic sh60m.

Others are Gulu Independent Hospital, sh150m, Mbarara Community Hospital, sh67m, St. Catherine Clinic, sh108m, Byansi Clinic, Masaka, sh8m and Rubaga Hospital, sh30m. Gulu Independent Hospital is the latest on the list to serve the company with a notice to sue.

Also owed unspecified amounts are Nsambya hospital, Bugolobi nursing home, SAS clinic, Mayanja Memorial Hospital, Pan Dental Surgery, Victoria Medical Centre and Nakasero Hospital among others. The other service providers that have suspended their services with the company over unpaid bills include Abii Clinic and Laboratory Services, Victoria Medical Centre and Friecca Pharmacy in Wandegeya.

The Microcare financial crisis comes at a time when the Government is planning to introduce a Social Health Insurance Scheme.

Ten of the affected health service providers have engaged Kizito, Lumu and Company advocates of Kampala seeking protection from the Uganda Insurance Commission. The health service providers have also filed a case at the High Court seeking to wind up Microcare.

Five companies acting as one
Health service providers are complaining that there are five companies using the name Microcare and acting as one entity. A look through the letters sent or agreement signed between several companies and Microcare, spells different names. There is Microcare, Microcare Health, Microcare Health Ltd, Microcare Insurance and Microcare Insurance Ltd.

The health service providers now fear that the company could easily close shop without paying what is due to them. “The Uganda Insurance Commission should inform us and the general public which company is registered under the laws of this country with the Insurance Commission to offer insurance cover to the public so that the public and other companies are protected from becoming victims as our clients are, currently,” the lawyers demanded.

To compound their worry further, the service providers said they do not know whether it is a registered insurance company since its files went missing from the registrar of companies. Further complicating matters are clauses in the agreement signed between health service providers with Microcare, which prevents them from directly reaching to Microcare clients. It also stipulates that Microcare has the right to reject a bill if the drug provided for is not agreeable to them, if doctor exaggerates a bill and when a hospital treats congenital illness.

“In accordance with the agreements, our clients have fulfilled their part and to their dismay, the insurance company has consistently failed to honour their part,” the lawyers complained to the Commission.

They claimed that Microcare has placed the bills under quarantine, instead of paying them. This, they said, was a breach of contract.

However, Microcare blames the delay in settling bills on incorrect or exaggerated bills. The hospitals dismissed this accusation. They said the Microcare desk at hospitals and clinics verifies the bills before any treatment is provided.

Affecting Operations
Saturday Vision has learnt that a number of private health centres wallow in debt, some of them resulting from heavy borrowing forced on them after insurance firms delayed to settle medical bills. Some facilities have either scaled-down their operations, are contemplating shutting down, or are shopping for investors to re-capitalise and resuscitate the businesses.

The Microcare mess is just one of the troubles facing health service providers. Several botched medical insurance schemes and expensive bank loans have pushed a number of up market private hospitals into financial difficulties.

For instance, the Uganda Revenue Authority (URA) recently almost closed down Kadic Hospital in Bukoto. The URA also raided the accounts of Paragon Hospital due to non-remittance of PAYE, exceeding sh79m.

“You send a bill of sh15m, they give you only sh8m. Each time you send them a bill, they retain a certain fee and eventually you find the bill accumulating,” said an executive director of a hospital.

Hospitals and clinics complained that these companies take several months, at times years, before settling their bills. The general contract with insurance companies is that they pay within 30 days of submitting an invoice, but many insurance companies take as long as 4-6 months before paying.

In turn, the hospitals borrow from banks at high interest rates to meet operational costs.

Weak health insurance sector
The scrapping of Microcare leaves only two companies, Medicare (under East African Underwriters) and Liberty (under Standard Bank Group of South Africa that trades here as Stanbic) licensed to provide medical insurance.

There are also Health Maintenance Organisations (HMOs) that operate in a way similar to health insurance companies – taking funds from individuals and companies to provide medical services in the long-term. Currently there are five HMOs in Uganda: Africa Air Rescue (AAR), International Health Network (IHN), International Air Ambulance (IAA), Kadic Health Foundation (KHF) and Case Medicare. However, their services are not regulated by any law.