Future of EA health insurance depends on better systems, not more products
Health Opinion
By
Moses Kuria
| Apr 08, 2026
Acting CEO of Carepay International and M-TIBA Moses G Kuria
Health insurance is one of the fastest-growing lines of business for many East African insurers. It has also long been one of the hardest to make sustainably profitable.
Premium volumes are rising, but margins remain fragile. In several markets, medical loss ratios approach or exceed breakeven even before administrative costs are considered.
The main constraint is no longer just demand. It is execution. Households want protection. Employers want predictable healthcare costs. The industry is collectively pushing for broader coverage. The demand is real.
Premium growth without operational control creates fragile businesses. When claims rise faster than expected, when provider billing patterns are inconsistent, and when fraud and waste go undetected for months, the model becomes unstable.
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Key stakeholders are now asking different questions. Beyond sales growth and expansion plans, they are examining the rising loss ratios, provider network stability, claims predictability, and pricing discipline. They want to understand how the combined ratio is expected to improve, not just how the top line is growing.
One of the least visible but most damaging weaknesses in health insurance is delayed data. When claims information arrives weeks or months late, pricing decisions rely on outdated assumptions. When utilisation patterns are unclear, risk is misjudged. When anomalies are detected too late, fraud, waste and abuse become expensive lessons rather than preventable events. Delayed data is the hidden risk on every insurer’s balance sheet.
Real-time visibility changes the equation. Earlier risk signals enable faster claims decisions. Pricing becomes more accurate because it reflects current utilisation patterns rather than outdated assumptions. Controls can be applied before losses compound.
Most importantly, provider payments become more predictable. For hospitals and clinics, slow claims settlement is not a minor inconvenience. It affects payroll, drug procurement, and service quality. In many African markets, the insurer and provider relationship has become quietly adversarial.
Providers worry about delayed payment and opaque claim decisions. Insurers worry about billing inflation and inconsistent coding. Members are caught in between. Without shared visibility and faster financial flows, distrust compounds on all sides.
The next breakthrough in African health insurance will not come from a new benefit design or a more aggressive distribution.
It will come from systems that connect members, providers, and insurers in real time, creating a single source of truth across the care-financing loop.
For years, the sector has focused on distribution. How do we sell more policies? How do we reach informal workers? How do we embed insurance into other services? These remain important questions. But the perspective now required is different: from selling more insurance to running insurance better.
The writer is the acting CEO of Carepay International and M-TIBA