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Toward mandatory health insurance in low-income countries? An analysis of claims data in Tanzania

Durizzo, K. and Harttgen, K. and Tediosi, F. and Sahu, M. and Kuwawenaruwa, A. and Salari, P. and Günther, I.. (2022) Toward mandatory health insurance in low-income countries? An analysis of claims data in Tanzania. Health economics, 31. pp. 2187-2207.

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Abstract

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.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Household Economics and Health Systems Research > Health Systems and Policy (Tediosi)
UniBasel Contributors:Tediosi, Fabrizio and Sahu, Maitreyi
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:1057-9230
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
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Last Modified:21 Dec 2022 18:42
Deposited On:21 Dec 2022 18:42

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