Borghi Josephine, Makawia Suzan, Kuwawenaruwa August
London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK and Ifakara Health Institute, Kiko Avenue, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78, 373 Dar es Salaam, Tanzania London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK and Ifakara Health Institute, Kiko Avenue, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78, 373 Dar es Salaam, Tanzania
London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK and Ifakara Health Institute, Kiko Avenue, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78, 373 Dar es Salaam, Tanzania.
Health Policy Plan. 2015 Feb;30(1):19-27. doi: 10.1093/heapol/czt093. Epub 2013 Dec 12.
Community-based health insurance expansion has been proposed as a financing solution for the sizable informal sector in low-income settings. However, there is limited evidence of the administrative costs of such schemes. We assessed annual facility and district-level costs of running the Community Health Fund (CHF), a voluntary health insurance scheme for the informal sector in a rural and an urban district from the same region in Tanzania. Information on resource use, CHF membership and revenue was obtained from district managers and health workers from two facilities in each district. The administrative cost per CHF member household and the cost to revenue ratio were estimated. Revenue collection was the most costly activity at facility level (78% of total costs), followed by stewardship and management (13%) and pooling of funds (10%). Stewardship and management was the main activity at district level. The administration cost per CHF member household ranged from USD 3.33 to USD 12.12 per year. The cost to revenue ratio ranged from 50% to 364%. The cost of administering the CHF was high relative to revenue generated. Similar studies from other settings should be encouraged.
基于社区的医疗保险扩展计划已被提议作为低收入环境中规模庞大的非正规部门的一种融资解决方案。然而，关于此类计划行政成本的证据有限。我们评估了运营社区健康基金（CHF）的年度机构和地区层面成本，CHF是坦桑尼亚同一地区一个农村和一个城市地区针对非正规部门的自愿医疗保险计划。从每个地区的两名机构的地区经理和卫生工作者那里获取了资源使用、CHF成员资格和收入方面的信息。估算了每个CHF成员家庭的行政成本以及成本收入比。在机构层面，收入收集是成本最高的活动（占总成本的78%），其次是管理和运营（13%）以及资金汇集（10%）。管理和运营是地区层面的主要活动。每个CHF成员家庭的行政成本每年在3.33美元至12.12美元之间。成本收入比在50%至364%之间。相对于所产生的收入而言，管理CHF的成本较高。应鼓励开展来自其他环境的类似研究。
