by Ben Taylor
Universal health insurance imminent
Preparations for the introduction of a universal and compulsory health insurance scheme are at an advanced stage, according to the Deputy Minister of Health and Social Welfare, Dr Godwin Mollel.
The law to govern the new insurance arrangements was enacted by parliament late in 2023 and signed by the President on November 10, 2023. However, it is up to the Minister to formally announce the date on which the implementation of the law will commence.
The Act aims to provide health insurance for all Tanzanian citizens, with special provisions for the financing of health care for the poor. It provides for reforms in regulation, governance, health service delivery and financing of health services to address the fragmentation of financing arrangements of existing health systems by combining the formal public health insurance and the Improved Community Health Funds (ICHF).
Under the new law, an equity fund will be established to subsidise premiums for low-income citizens and finance treatment for chronic diseases. This fund will be resourced through levies imposed on items such as carbonated drinks, alcoholic beverages and electronic transactions.
The Act stipulates the removal of exemptions previously granted in health care, compelling every Tanzanian to enrol in a health insurance scheme. Employers are now required to register their employees for health insurance within 30 days of employment commencement. Those who are in informal employment, are self-employed or unemployed are required to join a recognised community health fund.
In a sign perhaps of the difficulties associated with such a major shift in health policy, a dispute arose in late February between the largest government provider of health insurance, the National Health Insurance Fund (NHIF) and several major hospitals. NHIF issued a new schedule of prices that it would be willing to pay for specified services, prompting hospitals in the Association of Private Health Facilities Tanzania (APHFTA) and the Christian Social Service Commission (CSSC) to suspend provision of services to NHIF members.
APHFTA said the new rates were around 20-30% lower than before and presented the hospitals with an impossible situation. A source at the group told The Citizen newspaper that profit margins were previously around 10%, and with the new prices, facilities could face up to a 30% loss on some treatments.
Within days, however, the situation had been largely resolved, and provision of services to NHIF members resumed in most hospitals in early March.