Fresh calls for health insurance regulator

Dar es Salaam. A regulatory body to streamline costs that health providers charge must be an integral part of the planned universal health insurance coverage, some experts said yesterday.

This view by experts in the insurance sector comes at a time when the government is preparing a bill on the establishment of the universal health coverage and table it in Parliament during sittings that start today.

“I want to assure you that during the forthcoming Parliamentary sessions, we expect to pass a legislation that will introduce universal health insurance coverage,” President Samia Suluhu Hassan said during an event to mark 50 years of the founding of Catholic Women of Tanzania Association (Wawata) in Dar es Salaam at the weekend.

The President noted that her government was aware of the challenges facing the National Health Insurance Fund (NHIF), promising that the necessary steps would be taken to ensure that an institution that will be responsible for the universal health insurance coverage would be stable and guided by new legislation, regulations and policies to guide the healthcare service delivery to all Tanzanians.

Speaking to Mwananchi Communications Limited (MCL) editors last week, a team of senior officials from NHIF said the sector needed a regulator, saying in absence of such a body, health service providers were charging in line with their whims thus making it difficult for some people to get services at some facilities despite holding insurance cards.

Also read on: NHIF: Why health insurance sector needs oversight body

“We are talking of a body like Ewura [Energy and Water Utilities Regulatory Authority] that would regulate prices that health providers charge patients,” said NHIF’s Marketing and Customer Service manager Hipoliti Lello who was in the company of other senior officials in a delegation that was led by NHIF’s Information Communication Technology (ICT) director Alexander Sanga.

For its part, the Association of Tanzania Insurers (Ati) said the body to regulate prices that health service providers charge will have come at the right time because its members were also going through similar challenges as those facing NHIF.

The challenges facing health insurance providers as listed by Ati include lack of regulatory oversight over prices for health care services and increase of fraudulent practices like provision of services to non-beneficiaries.

The list also includes inflation of claims cost, weak regulatory oversight on medical practice by practitioners for instance treatment not following standard treatment guidelines, over-investigation and over-prescription.

“It should be noted that these challenges contribute to an increase in cost of purchasing medical insurance cover and eventually may lead to the collapse of the insurance system,” said Ati chairman Khamis Suleiman.

He said the private insurance companies are in support of the move to have a combined oversight body which will regulate prices of medical services, medical practice and reduce fraud.

“The private insurance companies take pride in supporting the government in financing provision of health services to Tanzanians, provision of employment opportunities and a source of revenue to the government,” he said.

Apart from NHIF, Tanzania is also home to six health insurance companies under the private sector.

These are Jubilee, Stategis, Assemble, Britam, Mo and GA.

A board member of Ati, who doubles as the chairman of Association of Tanzana Insurers, Dr Harold Adamson, said should the regulatory body be instituted, its formation should involve all key players including regulators of the two professions, private insurance companies, health facilities representatives and NHIF.

“Through this [proposed] body, our regulator Tanzania Insurance Regulatory Authority (Tira) can also have an oversight of the providers who are accredited by insurance companies,” said Dr Adamson.

Experts noted that in the absence of a regulatory body over health care charges, service providers have all the freedom to charge at their own discretion, meaning that inflated pricing was not uncommon.

“Some hospitals have been engaging in a lot of fraudulent practices, which could have been one of the factors that have put NHIF at the risk of collapsing and hinder several other insurers’ complaints,” the President of the Medical Association of Tanzania (Mat), Dr Shadrack Mwaibambe, told The Citizen yesterday, noting that the establishment of a regulatory body would reduce such tendencies.

According to him, a regulatory body will harmonise costs and bring in place a price that will cut across and consider a win-win situation between insurance firms and hospitals.

Like Dr Adamson, Dr Mwaibambe noted that in order to effectively tackle complaints raised by patients, hospitals and insurers should have a neutral regulatory system and one oversees various stakeholders.

Tanzania Diabetes Association (TDA) chairman Andrew Swai said the issue of universal health insurance should have been introduced a long time ago in the country because the health of every individual was important to the country’s economic development efforts.

Prof Swai noted that having a regulatory body was another vital thing that would help control the price of medications and enable the country to invest in the prevention and so save the high cost of treatment.