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CALL: Scale up health insurance coverage in low-income settings

Aug. 26, 2022
CALL:  Scale up health insurance coverage in low-income settings
A snip from the journal which published the research findings. GRAPHIC | IFAKARA/KMC.

Scientists from Tanzania and Switzerland have presented evidence underlining the need for policymakers to identify opportunities and barriers to scaling up health insurance coverage, particularly in Africa's low-income settings.

Findings of their study entitled: “Toward mandatory health insurance in low-income countries? An analysis of claims data in Tanzania” were published by the Wiley Online Library journal on August 7, 2022. Contributors included August Kuwawenaruwa from Ifakara along with colleagues from ETH Zurich, Swiss Tropical and Public Health Institute (Swiss TPH), and the University of Basel – all from Switzerland.

“This analysis is unique in that it is the first comprehensive analysis of a large-scale mandatory health insurance database for any African country,” they say.

The study analyzed 26 million claims submitted to the Tanzanian National Health Insurance Fund (NHIF), which covers two million public servants for whom public insurance is mandatory, to understand insurance usage patterns, cost drivers, and financial sustainability.

“This study is one of the first using administrative health insurance claims data to provide insights into the usage and cost structure of a mandatory national health insurance in a low-income setting and the financial sustainability that would be associated with scaling up the NHIF to a national health insurance scheme,” say the scientists.

The NHIF in Tanzania has 2.3 million subscribers, corresponding to about 4% of the population in Tanzania. Since the NHIF is mandatory for all Tanzanian public servants, the study avoided possible biases in the results due to adverse selection in the form of self-selected high–risk individuals into the insurance.

However, scaling up NHIF coverage in Tanzania would be extremely challenging, the scientists concluded in their study findings and have urged policymakers to make significant decisions.

“We find that for a sustainable national scale-up, policymakers will have to decide between reducing the essential package of health care covered by the scheme, deepening financial resources, asking poorer populations to also contribute through insurance premiums, or investing in disease prevention or some combination of the above,” they argue.

Read their findings here.