Transcript Update from Health Financing meeting conducted on 6th

Technical Review Meeting (TRM),
Blue Pearl 6-8 September, 2010
Department of Policy and Planning

Background
◦ `Objective Of the Meeting

Areas covered

Issues raised

Way Forward
 Provide
evidence to inform the
scale up of health insurance in
Tanzania
 Identify
key steps to achieve UC
 Historical
background and
Situation analysis
 Who
pays and who benefits?
 FIA
pro poor
 BIA
pro rich



In Tanzania, compared to other countries,
health financing to be more or less
progressive
Benefits are similar as in other countries,
are regressive
The typical distributions of the poor going
to lower level facilities.




The CHF is regressive by design
Matching grant - Is it not perpetrating
inequity?
A flat rate premium, means everyone pays
the same irrespective of income
The scheme also targets the poorest.

Concern
◦ If coverage were to expand and
premia to increase, the regressivity
of the CHF would be an issue

Current status of the NHIF and CHF
◦ Support to poor pregnant women

SHIB
◦ Formal Private and planning for informal

Private sector
◦ Private firms

◦
Micro insurances
◦

All NSSF members contribute but very
few benefit, SHIB members contribute
but NOT benefiting from the scheme

Health Funders Board

Adverse Selection


Price inflation (prices charged by private
providers),
Patients not respecting referral system




Weak management – especially CHF and
Micro
Limited benefit package
Establishment of district drug buffer stocks
for supplementary drug supply
Need to wake up a sleeping giant.
◦ Establishment of bank accounts and petty
cash
 No
incentives for districts to promote
CHF
 Office
bearers of the scheme are often
overburdened and not full-time
professionals.
 Poor
health insurance literacy within
the population

Regulatory framework for health insurance
◦ Many players
◦ Different perspectives
◦ Some how different objectives
◦ Should we put health insurance in social
security or leave it out?
◦ Contributions of the community are
rather limited, hence low enrolment
 How are we going to handle the informal
sector? Exempt? Or pay for them and issue
a card? Who will pay for them?
◦ Scaling-up for universal coverage is also
implying an increase in usage of services
– need for supply side investment to meet
increased demand
◦ Fragmentation is an issue
 Affects financial sustainability and
equity

Modeling - Options to expand health
insurance in Tanzania. Done in shorter time
◦ UC per se would have limited impact on GDP and
gvt exp on health,
◦ HOWEVER

HSS WILL REQUIRE HUGE INVESTIMENT
◦ Key lesson from other countries
 Fund authority response to Insurance
Scheme
 Earmarked tax works - Ghana and
Thailand
 It is possible to collaborate with social
security fund need action -


A minimum package of Health and Related
Management Activities
The required inputs and outputs will be
determined as per level of care.
Essential Health Package(EHP)/Services per
level of care


Review the Service Agreement

Review the stock list at MSD and TFDA per level
of care
◦ Medicines
◦ Devices
◦ Reagents



MOHSW + PMORALG +PARTINERS + MSD+TFDA
Expand Network at all Levels for both public and
private as per MMAM and Policy.
PPP

Universal Coverage of the Financing
Agenda i.e Social H.I Scheme◦ Action Plan
◦ PRIVATE FORMAL
◦ INFORMAL
A

lot is in Place in use available Data
Need to develop a milestone for health
financing
 Financing Strategy