A STUDY conducted by the Ifakara Health Institute has shown that health insurance cover in the country benefits the rich at the expense of the poor.

The study conducted in three urban councils of Morogoro, Singida and Kinondoni and four rural districts of Mbulu, Singida, Kigoma and Kilosa collected outpatient and inpatient health care utilisation from 2,234 households.

"Researchers interviewed 1,686 beneficiaries of the Community Health Fund, 196 members of the Social Health Insurance Benefit (SHIB) scheme and 173 members of private health insurance schemes as well as 6,748 non-insured individuals," the report read in part.

Findings of the study showed that richer groups were covered by a wide range of health insurance schemes while poorer groups were covered by the Community Health Fund (CHF) and the Tiba Kwa Kadi (TIKA) fund that begun in 2009 for some urban councils.

It showed also that insurance increased intensity of outpatient care use especially for those aged between 5 and 50 years and influenced where people go for care, diverting people from informal drug shops to formal care.

"Increasing the availability of affordable insurance options for poorer groups and ensuring greater consistency in the benefits offered across schemes would help to improve health system equity," the study suggested.

Health insurance cover has been gradually increasing among the population since its introduction over a decade and data collected as part of the Strategies for Health Insurance for Equity in Less Developed Countries (SHIELD) in 2008 suggest that national coverage was around 9 per cent.

More recent figures released by the Ministry of Health and Social Welfare during the 2011 Technical Review meeting suggested that around 17.1 per cent of the national population were insured by the National Health Insurance Fund (NHIF) and other funds with NHIF leading with 9.8 per cent.

The Health Sector Strategic Plan III sets a target of 30 per cent health insurance coverage across the population by 2015. Justifying on the increase of coverage, the study showed that in 2008, the total percentage of those covered by insurance was 8.5 but this had jumped to 18.1 by 2011.

"In 2008 the per cent of NHIF members was 3.4 but in 2011 this has risen to 7.3 per cent while CHF/TIKA members rose from 4.0 to 9.8 per cent while that of other schemes has remained constant at 1 per cent," the study reported.

The study indicated that CHF members were much more likely to use public primary health facilities and less likely to go to faith based health providers than the uninsured in rural areas. It showed that NHIF members in urban areas were more likely to use private providers and public providers and public, whereas those in rural areas were more likely to go to public primary and faith-based facilities.

The report said that SHIB and private scheme members were more likely to use private providers. "Data on the use of health care services are highly valuable for resource planning and insurance scheme management as this helps to identity possible system abuse, and alert providers to system overload, it would therefore be useful to address the lack of publicly available data of this nature," it read in part.

The study cited that the inequity in service availability between urban and rural areas should also be taken into account when setting premiums for schemes, and parallel efforts should be made to increase provider choice for those living in rural areas.