NDLI: Risk distribution across multiple health insurance funds in rural Tanzania.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Chomi, Eunice Nahyuha Mujinja, Phares Gamba Enemark, Ulrika Hansen, Kristian Kiwara, Angwara Dennis
Spatial Coverage	Tanzania
Description	Country affiliation: Denmark Author Affiliation: Chomi EN ( Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania ); Mujinja PG ( Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.); Enemark U ( Aarhus University, Aarhus, Denmark.); Hansen K ( London School of Hygiene and Tropical Medicine, London, United Kingdom.); Kiwara AD ( Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.)
Abstract	INTRODUCTION: Multiple 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. METHODS: Data 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. RESULTS: There 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. CONCLUSION: Mechanisms 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.
File Format	HTM / HTML
e-ISSN	19378688
DOI	10.11604/pamj.2014.18.350.3394
Journal	Pan African Medical Journal
Volume Number	18
Language	English
Publisher	African Field Epidemiology Network
Publisher Date	2014-01-01
Publisher Place	Uganda
Access Restriction	Open
Subject Keyword	Discipline Medicine Insurance, Health National Health Programs Patient Acceptance Of Health Care Statistics & Numerical Data Logistic Models Multivariate Analysis Risk Factors Rural Population Socioeconomic Factors Tanzania Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article

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