Epidemiology and Public Health, University of Basel, Basel, Switzerland
Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland.
BMJ Open. 2023 Aug 18;13(8):e070451. doi: 10.1136/bmjopen-2022-070451.
This study aimed to model the long-term cost associated with expanding public health insurance coverage in Tanzania.
DESIGN, SETTING AND PARTICIPANTS: We analysed the 2016 claims of 2 923 524 beneficiaries of the National Health Insurance Fund in Tanzania. The analysis focused on determining the average cost per beneficiary across 5-year age groups separated by gender, and grouped by broad health condition categories. We then modelled three different insurance coverage scenarios from 2020 to 2050 and we estimated the associated costs.
Average cost per beneficiary and the projected financing requirements, projected from 2020 to 2050.
The analysis revealed that the average per beneficiary cost for insurance claims was $38.58. Among males over 75 years, the average insurance claims costs were highest, amounting to $125. The total estimated annual cost of claims in 2020 was $151 million. Under the status quo coverage scenario, total claims were projected to increase to $415 million by 2050. Increasing coverage from 7% to 50% would result in an additional financing requirement of $2.27 billion. If coverage would increase by 10% annually, reaching 56% of the population by 2050, the additional financing need would amount to $2.84 billion.
This study highlights the critical importance of assessing the long-term financial viability of health insurance schemes aimed to cover large segments of the population in low-income countries. The findings demonstrate that even without expansion of coverage, financing requirements for insurance will more than triple by 2050. Furthermore, increasing coverage is likely to substantially escalate the cost of claims, potentially requiring significant government or external contributions to finance these additional costs. Policymakers and stakeholders should carefully evaluate the sustainability of insurance schemes to ensure adequate financial support for expanding coverage and improving healthcare access in low-income settings.
本研究旨在构建与坦桑尼亚扩大公共医疗保险覆盖范围相关的长期成本模型。
设计、设置和参与者：我们分析了坦桑尼亚国家健康保险基金 2923524 名受益人的 2016 年理赔数据。分析重点是确定按性别划分的 5 年年龄组内每个受益人的平均成本，并按广泛的健康状况类别进行分组。然后，我们构建了 2020 年至 2050 年三种不同的保险覆盖情景，并估计了相关成本。
每个受益人的平均成本和 2020 年至 2050 年预计的融资需求。
分析表明，保险理赔的每个受益人的平均成本为 38.58 美元。在 75 岁以上的男性中，保险理赔的平均费用最高，达到 125 美元。2020 年预计的年度理赔费用总计为 1.51 亿美元。在现状覆盖情景下，预计到 2050 年总理赔额将增加到 4.15 亿美元。将覆盖范围从 7%扩大到 50%将导致额外的 22.7 亿美元融资需求。如果覆盖范围每年增加 10%，到 2050 年达到 56%的人口，额外的融资需求将达到 28.4 亿美元。
本研究强调了评估旨在覆盖低收入国家大部分人口的医疗保险计划的长期财务可行性的重要性。研究结果表明，即使不扩大覆盖范围，到 2050 年，保险的融资需求也将增加两倍以上。此外，扩大覆盖范围可能会大幅增加理赔费用，这可能需要政府或外部大量捐款来为这些额外费用提供资金。政策制定者和利益相关者应仔细评估保险计划的可持续性，以确保为扩大覆盖范围和改善低收入环境中的医疗保健提供足够的财政支持。
