When health insurance equals the new ‘free goody’

20Jan 2019
Francis Semwaza
Guardian On Sunday
When health insurance equals the new ‘free goody’

THE growing mentality of preferring cash clients over those covered through insurance could be a blow to the immature health insurance sector in Tanzania, making it susceptible to failure should it not be enforced as among requirements in the definitive employee hiring processes.

Private health insurance providers’ approach leaves behind most Tanzanians uninsured while finding it difficult to be accepted in state-funded healthcare facilities countrywide. Photo: File

An informal survey of both in-patient and out-patient services in most healthcare facilities reveals that those who pay for treatment through insurance receive less priority and attention, thus services of less quality compared to those paying cash.

This is true in both public and private healthcare facilities, a sad reality that calls for addressing through awareness raising among healthcare professionals, facility owners and superintendents, the government, and the people who experience such discrimination in one way or another.

It makes the matter more complex when other healthcare facilities discriminate health insurance systems by accepting private companies such as AAR, MGen and Strategis, for instance, while rejecting the mass-covering National Health Insurance Fund (NHIF) than better negotiating the terms toward a win-win situation between the insurance companies and healthcare service providers.

While the state-run health insurance arrangement, NHIF, must be enjoying wider market coverage and support than private insurers, the hospitals’ preference for private health insurance vendors must attract a research interest given its anomalous behaviour.

It would make sense for any business to focus on the larger population for marketing purposes, and NHIF would be the real deal had everything been normal. The otherwise deviance, then, would be described hypothetically that things are not the way they should or have been expected to be in the relationship between private healthcare service providers and the NHIF.

It could be that maybe the state-run insurer delays in reimbursing the hospitals, thus making them unable to operate normally, or that the hospitals find it hard to manipulate the system for undue reimbursements, a situation that is not uncommon in the corrupt-prone environments characterizing the majority of Third World countries.

It could also be a case that the high-end private insurers pay greater returns and cover more illnesses and services than NHIF doesfor its clients. All and anything seems to be a possibility.

Yet, private health insurance providers’ approach leaves behind most Tanzanians uninsured while finding it difficult to be accepted in state-funded healthcare facilities countrywide.

The hiccups are happening amid efforts at raising awareness and sensitizing the public about the importance of health insurance following government’s inability to provide free healthcare services to the people, as it was the case in the past until the late 1980s.

The introduction of cost-sharing mechanism in education and healthcare services was not cheered by the people, who were at the same time having the heads of their households being forced into early retirement as among measures to reduce government spending.

Consequently, school enrollment and healthcare seeking behavior had deteriorated in most developing countries hardly thirty years since attaining independence, writes Martha Swantz in her 1996 research paper funded by and developed for the United Nations University and its numerous audiences.

Until today, the situation has not been rectified: while people are more concerned about the cost of services, insurance also proves expensive to the unemployed and generally low-income citizens, the groups to which most Tanzanians belong.

It is for this reason that even people’s subscription to healthcare insurance remains low, with statistics showing that only about 7 per cent of Tanzanians had bought health cover from the National Health Insurance Fund (NHIF) by June 2013 and only 7.3 per cent had subscribed to the low-cost Community Health Fund (CHF).

The situation definitely calls for increased efforts at making people realize the significance of buying health insurance in the midst of government inability to provide free services for its people on the one hand, and the rising costs of accessing healthcare services on the other.

In view of the ongoing situation, it would then be prudent to channel economic empowerment in awareness creation and other health insurance sensitization campaigns so that the target population would be able to increase their incomes with part of it eventually going to health insurance.

However, these efforts could be hampered by the growing tendency of considering patients paying through health insurance as of less priority compared to those paying cash, something that would make a greater part of the population ignorant of the need and significance of health insurance.

As a result, the majority of Tanzanians will continue being unable to access the otherwise affordable healthcare services on the one hand, and subject the insurance companies to a continuously shrinking market that would have been tapped should education and non-discriminating healthcare services have been at the centre of health insurance awareness endeavor.

In addressing the ensuing challenges, then, the awareness efforts should also target owners and staff in both private and public healthcare facilities to urge them to offer equal services to patients paying upfront and those using health insurance.

The writer is a development communications consultant based in Dar es Salaam. E-mail: [email protected].