Towards mandatory health insurance?
How do people in a low-income country use health care services if they are enrolled in a mandatory health insurance? An analysis of 26 million claims submitted to a Tanzanian mandatory health insurance provides first insights.
Many countries on the African continent strive towards “universal health coverage”, so that people do not suffer financially because of seeking health care. However, high health spending still persists across low-income countries (LICs), which impoverishes households. Private health expenditures can be reduced by expanding free health care services and/or scaling up health insurance coverage. Currently, health insurance coverage is not more than 10% in most African countries.
One of first analyses of insurance claims data in a low-income country
What does it mean to make health insurance mandatory in LICs? For high-income countries (HICs), insurance claims data have been analysed frequently to provide answers to service utilization and health care costs. However, such studies have barely been conducted for LICs. ETH NADEL researchers together with colleagues from the Ifakara Health Institute, Tanzania, and the Swiss Tropical and Public Health Institute analysed 26 million claims submitted to the Tanzanian National Health Insurance Fund (NHIF), which is a mandatory health insurance for all Tanzanian public sector employees.
Health insurance does not always lead to higher health access
Only 50% use the insurance in a given year, with the poorest and the richest being less likely to use their health insurance. This suggest that mandatory enrolment in a health insurance scheme may, on its own, be insufficient to guarantee access to health care and financial protection. The rich might opt to pay privately and the poorest might still be limited by transportation costs to health centres.
National mandatory health insurance is financially challenging
On average, about 30US$ is spent for each policyholder. An extrapolation of NHIF costs and revenues shows that NHIF would not be financially sustainable if health insurance coverage were to be extended to the entire Tanzanian population. The government will need to subsidize the insurance with tax-based revenues or international funds, or by increased insurance premiums. As an alternative or complementary policies, the government might want to aim to reduce costs by investing in disease prevention and/or reducing the health services covered.
Replication studies for other low-income countries are warranted
The analysis also shows large differences in health care utilization and cost structure between Tanzania and HICs such as Switzerland. The results emphasize that little can be learned about LICs from the multiple insurance claims studies from HICs, demonstrating the need for further studies using health provision data in LICs.