Abstract
IntroductionMultiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households.MethodsData was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests were performed to test whether the distribution of identified risk factors varied across the CHF, NHIF and non-member households.ResultsThere was a higher concentration of identified risk factors among CHF households compared to those of the NHIF. Non-member households have a similar wealth status to CHF households, but a lower concentration of identified risk factors.ConclusionMechanisms for broader risk spreading and cross-subsidisation across the funds are necessary for the promotion of equity. These include risk equalisation to adjust for differential risk distribution and revenue raising capacity of the funds. Expansion of CHF coverage is equally important, by addressing non-financial barriers to CHF enrolment to encourage wealthy non-members to join, as well as subsidised membership for the poorest.
Highlights
Health systems that rely on health insurance to finance health care often have multiple insurance funds covering different segments of the population
The main health insurance schemes currently in operation include the National Health Insurance Fund (NHIF), mandatory for public sector employees; the Community Health Fund (CHF), voluntary and district based for the rural population, with an urban equivalent for the informal population, „Tiba Kwa Kadi‟ (TIKA) and the Social Health Insurance Benefit (SHIB) for members of the National Social Security Fund (NSSF)
CHF households, with a mean household size of 5.3, were larger than NHIF and non- member households, which both had a mean size of 4.7 members (ρ
Summary
Health systems that rely on health insurance to finance health care often have multiple insurance funds covering different segments of the population. In low-income countries, this is regarded as the most feasible option for securing universal access to quality and affordable health care services [1,2,3] This often implies a variation in the distribution of health risks among the different health insurance funds. It has been argued that such fragmentation leads to inefficiency, limits risk pool sizes and expansion of coverage to those who cannot afford to pay for insurance [5,6,7] Such fragmentation may compromise equity within the health system due to differential revenue raising capacities and differential distribution of health risks to the extent that high risk members are unequally distributed among health insurance funds [3, 8, 9]. The CHF and NHIF are the predominant funds, with coverage reaching about 6.6% and 7.2% respectively of the population in 2009 [13]
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