We must make health insurance scheme tick

BY EDITOR

15th March 2013

Editorial Cartoon

The establishment of the National Health Insurance Fund in 1999 was an achievement with little record in Tanzania’s history, and Tanzanians ought to genuinely take pride in the development.
The mere look of relief on the faces of many of NHIF members as they are attended to in our hospitals, without the issue of cost being raised, elicits much happiness and joy.

Before the Fund’s launch, one could sense so much distress and all manner of not so positive facial expressions among the people that one would think the power of waiving the fee lay in the hands of care providers.

With the launch of NHIF, though, the gravity of some of the problems of old including that of people seeking medical too late has been appreciably reduced.
Admittedly, problems remain that must be addressed to ensure proper management of this scheme without unduly burdening the healthcare providers or giving clients a raw deal.

We live in a country where many facilities are mishandled and misused with impunity in part owing to the absence of workable and therefore easily enforceable checks and balances.

There are people who will visit hospitals on countless occasions within a short period, some for good reasons but others simply because there is “free” service on offer.

Whole families come reporting to the hospital, only for the practitioner to discover that only one of them is really sick, with the rest making the trip just for its sake. 

This needlessly increases the patient load, stretching the limited supplies in stock.

There is the issue of costing, where the health insurance scheme basically pays the facility a fixed amount, irrespective of the services rendered. The idea is agreeable since some facilities may take the liberty to inflate bills.

But for some chronic conditions like diabetes that require extensive laboratory investigations, costs can be really high particularly if it entails patients being admitted.

Late payment of bills is also something that should be dealt with so that it does not erode any gains made and cause more difficulties for hospitals when payments are made months after services are rendered.

Tanzania isn’t the only country practising a health insurance scheme of this kind, and we can easily borrow a leaf from the experience of other countries.

Case by case cost assessments and evaluations should be made so that chronic or life-threatening medical conditions are treated as special cases and medical attention is readily available even before payments are effected.It’s only human, after all.

Given the influx of patients precipitated by growth in NHIF members, some hospitals will have to be upgraded, expanded and better staffed and equipped to meet.

In part, that would reduce the risk of NHIF members complaining that they are treated as second-class patients simply because they go to hospital not with cash but brandishing special IDs.

  

These are some of the methods that could be employed to ensure that the hospitals can, at least, break even and continue to provide quality care rather than earn a bad name.

In a word, a lot more must be done to improve NHIF services if the scheme is to weather competition and serve members to satisfaction.

SOURCE: THE GUARDIAN