Risk distribution across multiple health insurance funds in rural Tanzania

Eunice Nahyuha Chomi; Phares Gamba Mujinja; Ulrika Enemark; Kristian Hansen; Angwara Dennis Kiwara

doi:10.11604/pamj.2014.18.350.3394

Risk distribution across multiple health insurance funds in rural Tanzania

Eunice Nahyuha Chomi, Phares Gamba Mujinja, Ulrika Enemark, Kristian Hansen, Angwara Dennis Kiwara

Section of Health Services Research

4 Citations (Scopus)

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.

Original language	English
Article number	350
Journal	Pan African Medical Journal
Volume	18
ISSN	1937-8688
DOIs	https://doi.org/10.11604/pamj.2014.18.350.3394
Publication status	Published - 2014

Keywords

Data Collection
Humans
Insurance, Health
Logistic Models
Multivariate Analysis
National Health Programs
Patient Acceptance of Health Care
Risk
Risk Factors
Rural Population
Socioeconomic Factors
Tanzania
Journal Article
Research Support, Non-U.S. Gov't

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@article{2907292408ce4653a51dcabc54847716,

title = "Risk distribution across multiple health insurance funds in rural 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.",

keywords = "Data Collection, Humans, Insurance, Health, Logistic Models, Multivariate Analysis, National Health Programs, Patient Acceptance of Health Care, Risk, Risk Factors, Rural Population, Socioeconomic Factors, Tanzania, Journal Article, Research Support, Non-U.S. Gov't",

author = "Chomi, {Eunice Nahyuha} and Mujinja, {Phares Gamba} and Ulrika Enemark and Kristian Hansen and Kiwara, {Angwara Dennis}",

year = "2014",

doi = "10.11604/pamj.2014.18.350.3394",

language = "English",

volume = "18",

journal = "Pan African Medical Journal",

issn = "1937-8688",

publisher = "African Field Epidemiology Network (A F E N E T)",

}

TY - JOUR

T1 - Risk distribution across multiple health insurance funds in rural Tanzania

AU - Chomi, Eunice Nahyuha

AU - Mujinja, Phares Gamba

AU - Enemark, Ulrika

AU - Hansen, Kristian

AU - Kiwara, Angwara Dennis

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Data Collection

KW - Humans

KW - Insurance, Health

KW - Logistic Models

KW - Multivariate Analysis

KW - National Health Programs

KW - Patient Acceptance of Health Care

KW - Risk

KW - Risk Factors

KW - Rural Population

KW - Socioeconomic Factors

KW - Tanzania

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.11604/pamj.2014.18.350.3394

DO - 10.11604/pamj.2014.18.350.3394

M3 - Journal article

C2 - 25574326

SN - 1937-8688

VL - 18

JO - Pan African Medical Journal

JF - Pan African Medical Journal

M1 - 350

ER -

Risk distribution across multiple health insurance funds in rural Tanzania

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Keywords

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