Modelling the implications of moving towards universal coverage in Tanzania
Modelling the implications of moving towards universal coverage in Tanzania
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DOI：
10.1093/heapol/czs009
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发表时间：
2012-03-01
影响因子：
3.2
通讯作者：
Ally, Mariam
中科院分区：
文献类型：
--
作者：
Borghi, Josephine;Mtei, Gemini;Ally, Mariam
开发了一个模型，以评估坦桑尼亚在15年时间框架内实现全民覆盖的可能举措的影响。考虑了三种情况：维持现状；扩大医疗保险覆盖范围（在没有保费补贴的情况下，估计可达到的最大覆盖范围，仅限于有能力支付的人）；全民医保（政府收入用于支付穷人的保险费）。该模型估计了向人口提供公共卫生服务和所有卫生服务的成本占国内生产总值（GDP）的比例，并预测了使用费和保险费的收入。在目前情况下，10%的人口通过健康保险计划获得财务保护，其余人口则享受公共设施的用户补贴费用。在扩大覆盖情景下，76%的人口将受益于通过健康保险获得的财务保护，而在普遍覆盖情景下，100%的人口将通过保险和政府供资的混合方式获得这种保护。扩大和全面覆盖方案对利用率有显著影响，特别是对公共门诊服务。要实现全民覆盖，首先需要将用于公共卫生系统的GDP比例提高一倍。政府卫生支出将增加到政府总支出的18%。结果对加强卫生系统的成本、实际国内生产总值增长水平、提供者补偿率和行政成本很敏感。促进各保险计划之间更大程度的交叉补贴将为全民覆盖提供充足的资源。另外，可以通过提高增值税税率或扩大所得税基数来增加卫生方面的税收资金。促进全民覆盖的努力的可行性和可持续性将取决于该系统控制费用的能力。
A model was developed to assess the impact of possible moves towards universal coverage in Tanzania over a 15-year time frame. Three scenarios were considered: maintaining the current situation ('the status quo'); expanded health insurance coverage (the estimated maximum achievable coverage in the absence of premium subsidies, coverage restricted to those who can pay); universal coverage to all (government revenues used to pay the premiums for the poor). The model estimated the costs of delivering public health services and all health services to the population as a proportion of Gross Domestic Product (GDP), and forecast revenue from user fees and insurance premiums. Under the status quo, financial protection is provided to 10% of the population through health insurance schemes, with the remaining population benefiting from subsidized user charges in public facilities. Seventy-six per cent of the population would benefit from financial protection through health insurance under the expanded coverage scenario, and 100% of the population would receive such protection through a mix of insurance cover and government funding under the universal coverage scenario. The expanded and universal coverage scenarios have a significant effect on utilization levels, especially for public outpatient care. Universal coverage would require an initial doubling in the proportion of GDP going to the public health system. Government health expenditure would increase to 18% of total government expenditure. The results are sensitive to the cost of health system strengthening, the level of real GDP growth, provider reimbursement rates and administrative costs. Promoting greater cross-subsidization between insurance schemes would provide sufficient resources to finance universal coverage. Alternately, greater tax funding for health could be generated through an increase in the rate of Value-Added Tax (VAT) or expanding the income tax base. The feasibility and sustainability of efforts to promote universal coverage will depend on the ability of the system to contain costs.