Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany.
Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.
Int J Health Policy Manag. 2023;12:6896. doi: 10.34172/ijhpm.2023.6896. Epub 2023 Feb 13.
Digital information management systems for health financing are implemented on the assumption thatdigitalization, among other things, enables strategic purchasing. However, little is known about the extent to which thesesystems are adopted as planned to achieve desired results. This study assesses the levels of, and the factors associated withthe adoption of the Insurance Management Information System (IMIS) by healthcare providers in Tanzania.
Combining multiple data sources, we estimated IMIS adoption levels for 365 first-line health facilities in2017 by comparing IMIS claim data (verified claims) with the number of expected claims. We defined adoption as abinary outcome capturing underreporting (verified<expected) vs. not-underreporting, using four different approaches.We used descriptive statistics and analysis of variance (ANOVA) to examine adoption levels across facilities, districts,regions, and months. We used logistic regression to identify facility-specific factors (ie, explanatory variables) associatedwith different adoption levels.
We found a median (interquartile range [IQR]) difference of 77.8% (32.7-100) between expected and verifiedclaims, showing a consistent pattern of underreporting across districts, regions, and months. Levels of underreportingvaried across regions (ANOVA: F=7.24, <.001) and districts (ANOVA: F=4.65, <.001). Logistic regression resultsshowed that higher service volume, share of people insured, and greater distance to district headquarter were associatedwith a higher probability of underreporting.
Our study shows that the adoption of IMIS in Tanzania may be sub-optimal and far from policy-makers'expectations, limiting its capacity to provide the necessary information to enhance strategic purchasing in the healthsector. Countries and agencies adopting digital interventions such as openIMIS to foster health financing reform areadvised to closely track their implementation efforts to make sure the data they rely on is accurate. Further, our studysuggests organizational and infrastructural barriers beyond the software itself hamper effective adoption.
健康融资的数字信息管理系统的实施假设，除其他外，数字化能够实现战略采购。然而，对于这些系统在多大程度上按照计划被采用以实现预期结果知之甚少。本研究评估了坦桑尼亚医疗保健提供者采用保险管理信息系统 (IMIS) 的程度和相关因素。
我们结合多个数据源，通过将 IMIS 索赔数据（经核实的索赔）与预期索赔数量进行比较，估计了 2017 年 365 家一线卫生机构的 IMIS 采用水平。我们使用四种不同的方法将采用定义为二进制结果，捕捉漏报（经核实的<预期）与未漏报，我们使用描述性统计和方差分析（ANOVA）来检查设施、地区、区域和月份的采用水平。我们使用逻辑回归来确定与不同采用水平相关的特定于设施的因素（即解释变量）。
我们发现预期和经核实的索赔之间的中位数（四分位距 [IQR]）差异为 77.8%（32.7-100），显示出整个地区、区域和月份的漏报一致模式。漏报水平在区域（ANOVA：F=7.24，<.001）和地区（ANOVA：F=4.65，<.001）之间存在差异。逻辑回归结果表明，更高的服务量、参保人数比例和更大的到地区总部的距离与更高的漏报概率相关。
我们的研究表明，坦桑尼亚的 IMIS 采用可能不理想，远远低于政策制定者的期望，限制了其提供必要信息以增强卫生部门战略采购的能力。采用开放式 IMIS 等数字干预措施来促进卫生融资改革的国家和机构应密切跟踪其实施工作，以确保其依赖的数据准确。此外，我们的研究表明，除软件本身之外，组织和基础设施障碍阻碍了有效采用。
