Experts highlight lessons from NHIF dispute with private hospitals ahead of UHI

Dar es Salaam. Insurance and economic experts have emphasized the need for the government to glean insights from the ongoing row between the National Health Insurance Fund (NHIF) and private health service providers so as to guarantee a smooth implementation of the planned Universal Health Insurance (UHI).

There has been a misunderstanding between NHIF and private health service providers since January this year over new rates for some medical services and medicines.

The misunderstanding, which saw the new rates halted after the private hospitals threatened to boycott NHIF members, has now entered another stage as the two sides agreed to continue with the services as they engage in further consultations.

Last week, several private hospitals announced the suspension of services to NHIF members. However, after careful reconsideration, they have since resumed providing services to NHIF insurance holders, even as they embark on further discussions with the government.

NHIF members are mostly government employees, whose contributions are deducted from their salaries.

However, some experts say under the UHI, participation will be more voluntary, calling for prioritising value for money.

“To resolve the ongoing dispute, it’s important to establish a pricing model,” said the director of research, consultancy, and international relations at the Africa College of Insurance and Social Protection (ACISP), Dr Anselimi Anselimi.

He pointed out that the NHIF crisis is rooted in the absence of a structured pricing model; instead, it relies on calculated assessments that are based on assumptions.

According to him, that is inadequate for the insurance sector.

"As a consequence, the fund found itself in a situation where expenditures were unbounded while revenues remained limited, leading to instability,” he said.

He stressed the urgency of implementing a pricing model that considers the prevailing market conditions.

He said the government must ensure that those handling claims possess genuine expertise in the insurance field to mitigate challenges such as fraud and overbilling.

“Failure to address pricing challenges could hinder the implementation of UHI, particularly as it relies more on voluntary participation,” he said.

Dr Anselmi stressed the need for convincing mechanisms and embracing digital technology to facilitate expenditure calculation for every member and service categorization.

An economics lecturer from the University of Dodoma (Udom), Dr Lutengano Mwinuka, said that improvements in the area of health services are essential.

“If we want to be effective in the planned UHI, we need to be willing to pay for it,” he said.

For her part, ACT Wazalendo Party’s Shadow Minister for Health, Dr Elizabeth Sanga, said in this crisis where the private sector wants more profit and the government wants to save costs for the NHIF, the affected are members.

She advised the government to look at the root cause of the problem because even if they still agree on those packages, they will still receive opposition from citizens who will not be able to afford the costs.

“The only scientific solution at the moment is to link the health service with social security,” she said.

“We urge the government to improve basic health services to prevent disease and reduce the number of people in referral hospitals,” she said.