Borghi, Josephine

Makawia, Suzan

English

Digital Library of the Tanzania Health Community

Impact of Health Insurance in Increasing equity of access: Exploring evidence using Benefit incidence analysis of 
Health services.
Authors: Suzan Makawia1, and Josephine Borghi2
1 Ifakara Health Institute, P.O Box 78373, Plot 463, Kiko Ave, Mikocheni, Dar es salaam, Tanzania; 2London School of Hygiene and Tropical Medicine
2th Symposium on Health systems research; Oct 31 – 3rd March, 2012. Beijing – China.
There is growing evidence of the effects of health insurance coverage on access to health services
in terms of health service use and reducing the burden of out of pocket payments which still
constitutes a large share of total health expenditure in many developing countries. However, there
is limited evidence as to the effect of health insurance on the distribution of health care benefits
within a benefit incidence analysis. This paper examines the effect of two health insurance
schemes in Tanzania, the community health fund (CHF) for informal sector and the National Health
Insurance Fund (NHIF) for formal sector, on total health care benefits and models the impact of
insurance expansion on total benefit incidence and distribution by wealth group.
Introduction
Key findings
NB: This poster presents the findings of one aspect of research project called SHIELD(Strategies for Health Insurance equity in Less developed countries), website http://heu-uct.org.za/research/projects/shield-project/
A system wide benefit incidence analysis was conducted including both public and non public
providers. Utilization and insurance scheme membership data were taken from a household survey
of 12,204 individuals in 2,204 households in six districts, in Tanzania conducted in 2008. Cost data
were derived from an analysis of reimbursements and claims from the NHIF. Mean benefits (In
Tanzanian shillings) by insurance status were calculated and non parametric (Mann Whitney) test
was used to test for statistical significance of the means. The impact of insurance expansion on total
benefits and distribution by wealth group was estimated using a simple spreadsheet model.
Methods
Conclusion
y
0
5
10
15
NHIF CHF UN INSURED
Figure 1: Mean Annual Per Capita Benefits by Insurance Status 
for Outpatient (OP) Care in ‘000,Tsh
Non Pub (Faith & Prv)
Public (sec & Tert)
Public Primary (HC + DISP)
0
5
10
15
20
25
NHIF CHF UN INSURED
Figure 2: Mean Benefits ‘000’ by Insurance Status for Inpatient 
care (IP) in Tsh
Non Pub (Faith & Prv)
Public (Referral+ 
regional hosp)
Public (health centre + 
District hosp)
0
20
40
60
80
NHIF CHF UN INSURED
Figure 3: Mean Annual benefits 
(OP & IP) ‘000’ by Insurance Status 
in Tsh
Public Non_pub Total (PUB+PRV+FBO)
Total benefits: mean total benefits from both public facilities and mean total benefits from
non public facilities were higher for NHIF members than CHF members and the uninsured
(p<0.01) (Figure 3). Overall mean benefits from all providers combined were significantly
higher for NHIF than CHF members and the uninsured (p<0.01).
Impact of Insurance Expansion on Benefit Incidence: Figure 4 shows total benefit
incidence among insured with current levels of insurance coverage (8.5%) and with
expanded insurance coverage (100%). The percentage change in total benefits for the
poorest is higher after expansion of insurance coverage compared to the least poor.
Outpatient care: mean annual public primary care benefits for CHF members was higher
compared to NHIF members (p<0.01) and the uninsured (p<0.01). Mean benefits from public
secondary and tertiary levels of care and non-public facilities were higher for NHIF members
(p<0.01) than other groups (Figure 1).
Inpatient care: Mean annual benefits for public primary care was slightly higher for CHF members
compared to NHIF (p<0.1) and Uninsured (p<0.01). There was no significant difference between
CHF and the uninsured for public outpatient referral care. Mean annual benefits from public
referral and regional hospitals were higher for NHIF members compared to CHF members and
uninsured (p<0.01) (Figure 2). No significant difference for the annual mean benefits between
NHIF, CHF and Uninsured for non-public facilities.
NHIF members are receiving more services both for OP and IP services, because of their
benefit package which covers both outpatient and inpatient care. The modeling results
indicate that health insurance expansion increase benefits among the poor. Therefore if the
health system goal is to increase health care benefits among the poor, policies and
initiatives to increase insurance coverage are urgently needed.
0
50000
100000
150000
200000
250000
Poorest 2nd 
Poorest
Middle 2nd 
richest
Least 
Poor
A
n
n
u
a
l
 
T
o
t
a
l
 
B
e
n
e
f
i
t
s
Fig. 4: Benefits (000’000) after 
Insurance expansion to whole 
population 
Status cuo After (30% insurance expansion)

Impact of Health Insurance in Increasing Equity of Access: Exploring Evidence Using Benefit Incidence Analysis of Health Services.

http://ihi.eprints.org/890/1/Poster(2).pdf

Impact of Health Insurance in Increasing Equity of Access: Exploring Evidence Using Benefit Incidence Analysis of Health Services.

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