Risk distribution across multiple health insurance funds in rural Tanzania
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 cros...
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| Format: | Article |
| Language: | English |
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The Pan African Medical Journal
2014-08-01
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| Series: | The Pan African Medical Journal |
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https://www.panafrican-med-journal.com/content/article/18/350/pdf/350.pdf
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| author | Eunice Nahyuha Chomi Phares Gamba Mujinja Ulrika Enemark Kristian Hansen Angwara Dennis Kiwara |
| author_facet | Eunice Nahyuha Chomi Phares Gamba Mujinja Ulrika Enemark Kristian Hansen Angwara Dennis Kiwara |
| author_sort | Eunice Nahyuha Chomi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-24T19:00:22Z |
| format | Article |
| id | doaj.art-096a60e07e85431ebf4ce18a92c17d5d |
| institution | Directory Open Access Journal |
| issn | 1937-8688 1937-8688 |
| language | English |
| last_indexed | 2024-12-24T19:00:22Z |
| publishDate | 2014-08-01 |
| publisher | The Pan African Medical Journal |
| record_format | Article |
| series | The Pan African Medical Journal |
| spelling | doaj.art-096a60e07e85431ebf4ce18a92c17d5d2022-12-21T16:43:13ZengThe Pan African Medical JournalThe Pan African Medical Journal1937-86881937-86882014-08-011835010.11604/pamj.2014.18.350.33943394Risk distribution across multiple health insurance funds in rural TanzaniaEunice Nahyuha Chomi0Phares Gamba Mujinja1Ulrika Enemark2Kristian Hansen3Angwara Dennis Kiwara4 Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Aarhus University, Aarhus, Denmark London School of Hygiene and Tropical Medicine, London, United Kingdom Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania 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. https://www.panafrican-med-journal.com/content/article/18/350/pdf/350.pdf health insurancerisk distributionrisk stratificationrisk pool fragmentationcross-subsidisation |
| spellingShingle | Eunice Nahyuha Chomi Phares Gamba Mujinja Ulrika Enemark Kristian Hansen Angwara Dennis Kiwara Risk distribution across multiple health insurance funds in rural Tanzania The Pan African Medical Journal health insurance risk distribution risk stratification risk pool fragmentation cross-subsidisation |
| title | Risk distribution across multiple health insurance funds in rural Tanzania |
| title_full | Risk distribution across multiple health insurance funds in rural Tanzania |
| title_fullStr | Risk distribution across multiple health insurance funds in rural Tanzania |
| title_full_unstemmed | Risk distribution across multiple health insurance funds in rural Tanzania |
| title_short | Risk distribution across multiple health insurance funds in rural Tanzania |
| title_sort | risk distribution across multiple health insurance funds in rural tanzania |
| topic | health insurance risk distribution risk stratification risk pool fragmentation cross-subsidisation |
| url |
https://www.panafrican-med-journal.com/content/article/18/350/pdf/350.pdf
|
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