analysisBy NHIF Research Team
ONE of the notable agenda in the just ended US Presidential Elections was health insurance for the middle class Americans and the poor who can not purchase the same.
The US economic downturn in the recent past had also led into trending up of health inflation reaching the unprecedented levels. Consequently, the majority of productive Americans were starting to be left out of the health insurance safety net. It was high time that reforms to help reduce spending in health care were enacted.
This led to the advent of the now very popular Obamacare (a name given to health insurance reforms sponsored by President Obama). Patient Protection and Affordable Care Act (PPACA) a.k.a Obamacare is a US federal law signed by the President representing a significant regulatory overhaul of the American health insurance system.
Among other things, it aims at increasing the number of insured Americans including those who could not afford any health insurance cover. Whether Obamacare succeeds or not, it is a legacy to the President as many predecessors tried to overhaul the corporate pro-rich health insurance system but things were not possible.
Given the above background, Obamacare sheds light on what should be done to achieve universal health coverage. The most important lessons to be drawn from Obamacare are explained next. The importance of universal coverage One important feature that the Obamacare can never work without is what is referred to as individual mandate whereby everybody is made to purchase affordable health insurance with exception of special groups that are already sponsored by other programmes.
Individual mandate also ensures sustainability of health insurance schemes due to the principle of large numbers i.e bigger number of risk and resource pools. Arguably, increasing the risk pool eventually reduces incentives for various discriminative practices for example insurance policies to be issued depending on a person's preexisting medical condition, insurers offering different premiums to applicants of the same age and geographical location and with regard to gender, setting of annual and lifetime coverage caps to service providers, large copayments, co-insurance, and deductibles to customers etc.
The National Health Insurance Fund is a good example of a Scheme where none of these discriminative practices take place. However, in order for this trend of good practice to continue, sustainability is very important. The Fund must endeavour to expand coverage so as to pull more resources so as to ensure sustainability and open room to possibly expand to the excluded groups such as the informal sector and the indigents.
The role of the Government in the revolution of health insurance including coverage of the poor and the disabled is very important and cannot be left untold. Promoting preventive care/health promotion Obamacare strictly states in the PPACA that "a group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for evidence-based items or services that have in effect a rating of 'A' or 'B' in the current recommendations of the US Preventive Services Task Force".
In that aspect, screening services or health check-ups are guaranteed. Apart from screening so as to prevent diseases, preventive care is done through counselling for various behaviours that may lead to serious diseases such as tobacco use, that is advocacy of healthy living styles. All this shows how important preventive care is. For this reason, health promotion is a permanent agenda for the NHIF.
In addition, to ensure that health facilities detect disease conditions earlier, the Fund invests in health related projects and also aids in financing of diagnostic equipment. Government subsidies in health insurance In a country such as Tanzania where the number of lower income people exceeds the middle class and the well-to-do, it is obvious that not everyone will be able to purchase health insurance.
These include the poor, the disabled, the elderly etc. For equity purposes, Obamacare includes two programmes that help to ensure that these groups also receive health insurance. These programmes are Medicare and Medicaid. The programmes are financed by payroll taxes. The lesson that can be drawn from this is that although there are some groups in the society that require help in purchasing health insurance, there must be a properly set mechanism whereby these people can be financed from general Government taxes.
In Tanzania, an inclusive health insurance system is very important now than ever before because costs of health care are becoming unbearable to be funded by outof- pocket when the disease strikes. Formal/Informal sector workers, the poor and the disabled all need some form of health insurance.
This is what we have come to call inclusive or universal health insurance coverage. Looking at the American example and drawing some best practice from our neighbour the Republic of Rwanda, universal health insurance coverage is only possible by streamlining and harmonizing health insurance laws and making them more accommodative of all social groups.