Toward mandatory health insurance in low-income countries? An analysis of claims data in Tanzania.
Tanzania
claims data
health insurance
scale-up
universal health coverage
Journal
Health economics
ISSN: 1099-1050
Titre abrégé: Health Econ
Pays: England
ID NLM: 9306780
Informations de publication
Date de publication:
10 2022
10 2022
Historique:
revised:
17
06
2022
received:
19
05
2021
accepted:
19
06
2022
pubmed:
8
8
2022
medline:
9
9
2022
entrez:
7
8
2022
Statut:
ppublish
Résumé
Many low-income countries are in the process of scaling up health insurance with the goal of achieving universal coverage. However, little is known about the usage and financial sustainability of mandatory health insurance. This study analyzes 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. We find that in 2016, half of policyholders used a health service within a single year, with an average annual cost of 33 US$ per policyholder. About 10% of the population was responsible for 80% of the health costs, and women, middle-age and middle-income groups had the highest costs. Out of 7390 health centers, only five health centers are responsible for 30% of total costs. Estimating the expected health expenditures for the entire population based on the NHIF cost structure, we find that for a sustainable national scale-up, policy makers will have to decide between reducing the health benefit package or increasing revenues. We also show that the cost structure of a mandatory insurance scheme in a low-income country differs substantially from high-income settings. Replication studies for other countries are warranted.
Identifiants
pubmed: 35933731
doi: 10.1002/hec.4568
pmc: PMC9543525
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2187-2207Informations de copyright
© 2022 The Authors. Health Economics published by John Wiley & Sons Ltd.
Références
Health Policy Plan. 2019 Nov 1;34(9):694-705
pubmed: 31539034
Bull World Health Organ. 2008 Nov;86(11):871-6
pubmed: 19030693
Basic Clin Pharmacol Toxicol. 2019 Jan;124(1):18-27
pubmed: 30260590
JCO Glob Oncol. 2020 Feb;6:224-232
pubmed: 32073912
BMC Public Health. 2008 Jul 04;8:228
pubmed: 18601718
BMC Health Serv Res. 2017 Apr 27;17(1):308
pubmed: 28449712
Trop Med Int Health. 2015 Aug;20(8):1093-107
pubmed: 25876515
World Dev. 2015 Feb;66:500-515
pubmed: 25648157
Int J Gynaecol Obstet. 2015 Jun;130 Suppl 1:S43-50
pubmed: 26054252
Lancet. 2009 Apr 25;373(9673):1447-54
pubmed: 19359034
PLoS One. 2018 Oct 31;13(10):e0206623
pubmed: 30379961
PLoS One. 2018 Aug 6;13(8):e0201833
pubmed: 30080875
JAMA. 2020 Mar 3;323(9):863-884
pubmed: 32125402
J Glob Health. 2016 Dec;6(2):020501
pubmed: 27606060
BMC Health Serv Res. 2019 Nov 20;19(1):848
pubmed: 31747932
Health Econ. 2010 Sep;19 Suppl:181-206
pubmed: 20593433
Int J Equity Health. 2016 Jul 22;15(1):116
pubmed: 27449349
Trop Med Infect Dis. 2018 Apr 12;3(2):
pubmed: 30274437
J Acquir Immune Defic Syndr. 2009 May 1;51(1):65-71
pubmed: 19282780
J Policy Anal Manage. ;36(2):390-417
pubmed: 28378959
PLoS Med. 2014 Sep 22;11(9):e1001731
pubmed: 25243899
Proc Natl Acad Sci U S A. 2018 Apr 10;115(15):E3463-E3470
pubmed: 29581252
Int J Equity Health. 2017 Feb 6;16(1):31
pubmed: 28166779
JAMA Intern Med. 2016 Oct 01;176(10):1501-1509
pubmed: 27532694
Health Policy Plan. 2019 Oct 1;34(8):582-594
pubmed: 31435674
BMC Nephrol. 2017 Jul 4;18(1):212
pubmed: 28676037
Pharm Res. 2001 Sep;18(9):1367-72
pubmed: 11683254
Health Econ. 2017 Apr;26(4):519-527
pubmed: 26799518
Value Health. 2012 Jan-Feb;15(1 Suppl):S132-8
pubmed: 22265060
BMC Health Serv Res. 2014 Nov 20;14:538
pubmed: 25411021
BMC Health Serv Res. 2015 Aug 15;15:331
pubmed: 26275412
Sci Data. 2019 Jul 25;6(1):134
pubmed: 31346183
BMC Health Serv Res. 2013 Jan 03;13:2
pubmed: 23286826
Int Health. 2018 Jan 1;10(1):1-3
pubmed: 29325056
Health Econ Policy Law. 2015 Jul;10(3):251-66
pubmed: 25116081
N Engl J Med. 2013 May 2;368(18):1713-22
pubmed: 23635051
BMC Health Serv Res. 2015 Nov 12;15:506
pubmed: 26563300
Bull World Health Organ. 2010 Jun;88(6):402
pubmed: 20539847
BMC Public Health. 2020 Apr 29;20(1):586
pubmed: 32349712
Soc Sci Med. 2012 Aug;75(4):595-603
pubmed: 22321392
JAMA. 2014 Jun 18;311(23):2437-9
pubmed: 24938568
PLoS Med. 2007 Oct;4(10):1584-8
pubmed: 17958467
Int J Equity Health. 2014 Mar 19;13:25
pubmed: 24645876
Int J Health Econ Manag. 2018 May 9;:
pubmed: 29740740
J Pharm Policy Pract. 2016 Feb 24;9:6
pubmed: 26913200
J Biosoc Sci. 1994 Oct;26(4):529-38
pubmed: 7983103
J Med Econ. 2014 Feb;17(2):148-58
pubmed: 24168640
Health Econ. 2022 Oct;31(10):2187-2207
pubmed: 35933731
Int J Health Plann Manage. 2014 Oct-Dec;29(4):e368-82
pubmed: 25551166
Parasit Vectors. 2014 Mar 28;7:132
pubmed: 24678612
Pain. 2009 Jul;144(1-2):20-7
pubmed: 19362417
Health Policy Plan. 2007 Mar;22(2):95-102
pubmed: 17299023
Health Res Policy Syst. 2013 Jun 13;11:21
pubmed: 23763711
Health Aff (Millwood). 2017 Jun 1;36(6):1119-1128
pubmed: 28515140
Int J Health Care Finance Econ. 2014 Dec;14(4):385-406
pubmed: 25143181
Health Econ. 2009 Jul;18 Suppl 2:S65-82
pubmed: 19267321
Ghana Med J. 2012 Jun;46(2):76-84
pubmed: 22942455
Health Econ. 2010 Sep;19 Suppl:95-106
pubmed: 20730999
PLoS One. 2018 Jun 1;13(6):e0198622
pubmed: 29856849