Why Universal Health Care Needs Effective Regulation

As parliament is expected to debate and possibly approve the 2022 Universal Health Insurance (UHI) bill this week, Tanzania Insurance Regulatory Authority (Tira) Insurance Director Dr Baghayo Saqware told The Citizen News editor Find out more in our exclusive interview with author Samuel. Kamdaya is the agency’s readiness to regulate the deal and why UHI is a game-changer in the history of Tanzania’s healthcare delivery and economy as a whole. excerpt:

Q. In a nutshell, what kind of Tanzania should we expect under the effectively regulated UHI?
A. We should expect a country with a completely transformed healthcare delivery and economy. An effectively regulated UHI system creates a situation where an insurer accumulates funds through his UHI premiums. These funds are held in commercial banks. If banks have sufficient liquidity, people can get loans at affordable interest rates. Its multiplier effect is easy to see.

With the bill introducing Tira as the holistic regulator of the insurance system, is your agency ready to take on that task?
First of all, it should be noted that the origin of UHI is the need to improve the delivery of health services among Tanzanians. This is a constitutional provision that obliges the government to ensure that all Tanzanians have access to quality healthcare. To achieve that, you basically need four things. The physical infrastructure of hospital buildings, diagnostic equipment, medical professionals, and funding. A critical analysis of these four shows that we have the building, the equipment, and the experts. But funding has always been a challenge. In the early years of our country’s independence, the government was perfectly able to handle the fundraising part, but then we realized that the exercise was wasting public resources. We have moved to cost sharing, which is also costly. He then decided that health insurance must be compulsory for all civil servants, which is why the National Health Insurance Fund (NHIF) was created. But it also leaves a significant portion of the population working in the informal sector.

At one point it was said that NHIF, an expert in the field, was not doing well financially, but why is that so and what should be expected of UHI?
The question is how we live as Tanzanians. Quite a few of us tend to seek health insurance coverage when we get sick. When a family member falls ill, I see relatives calling each other and donating so they can buy health insurance for their sick co-workers. This is the exact opposite of how the insurance sector operates. Insurers must have sufficient funds available before a client makes a claim. Your car should be insured so that you can claim reimbursement from your insurance company in the event of an accident. That said, UHI’s decision has nothing to do with what is happening at his NHIF.

Which of the UHI bill’s provisions can easily define its primary purpose?
Essentially, UHI requires citizens to have health insurance. This is because the health of Tanzanians is a constitutional matter for the government. We also decided to have a standard package. It also seemed good that the sector needed to be regulated and, ultimately, tied to other services if it were to be effectively mandated. That’s exactly why it was suggested that if you want to get a driver’s license or car insurance, you must also show your health insurance card.

Among the issues raised by some lawmakers during debates on the bill was that instead of giving Tila regulatory powers, a new agency might have been created to assume a UHI regulatory role. What do we have to say about it?
In short, there was a lot of misunderstanding regarding that particular aspect. Tila seeks to regulate insurance services, not medical services. Our duty is to outline the standards that must be followed by hospitals providing services under insurance policies. NHIF’s customers are now forced to lodge complaints with NHIF if they are dissatisfied with the service they receive. The goal of regulation is to protect the interests of both insurers and customers. Please note that insurance companies are not self-funded. They are run on money that belongs to individuals who contribute through premiums. So we need to regulate how insurers use it. For example, if the NHIF wants to invest in a real estate project, the regulator should come on board and issue principles on how money should be invested in the health of its members.

In short, how ready is Tira to take on the task?
It has been 26 years since Tira was a department of the Ministry of Finance. As such, we have sufficient experience and expertise to carry out that task. Secondly, there are already some guidelines to guide insurance activities within the country. Third, Tira has an organizational structure ideal for such a mission. It has a board of directors whose chairman is appointed by the President and whose members are appointed by the Minister of Finance. There is an Insurance Ombudsman and an Insurance Appeals Court. We have the Insurance Commissioner and his team of experts. They all exist to promote checks and balances in the conduct of insurance business. For example, if a customer is dissatisfied with the services provided by an insurance company, the customer submits a complaint to that company. If there is a complaint, he will send the complaint to his Tira, then to the Ombudsman, and finally to the High Court. It was established to protect the interests of the people and ensure the sustainability of the market. As part of his preparation for his role under UHI, he has created a special department within his Tira to regulate UHI. Its mission is to consider, among other things, health insurance and hospitals. There are enough experts here.The fourth aspect where you can expect a smoother ride is having a system like the Tira MIS already in place [a portal that manages motor insurance stickers and their respective cover notes]We have a risk-based monitoring system that allows us to check and alert you to any insurer’s risks. We have the right people who are well trained and qualified.

What are the best practices elsewhere?
When I say that there is no reason to consider creating a new agency to regulate UHI, it is because I understand that Insurance, Social Security and Mathematical Sciences are actually related courses. In fact, professionals in these fields study similar programs from the early stages of their studies until they choose their specialization. As such, in Namibia, all financial institutions not directly included in the central bank’s regulatory mechanism are governed by a single body known as the Namibian Authority for the Supervision of Financial Institutions (Namfisa). In Zambia, both insurance and pension funds are regulated by a regulatory body known as the Pensions and Insurance Authority (PIA), while Botswana has similar regulations to Namibia. In short, social protection and insurance are one thing, so separating them will only increase operational costs for no apparent reason. The principles are universal, which is why Tira is a member of the African Regional Regulators for Insurance and Non-Banking Financial Services, the East African Community, and the Southern African Development Community. Tira regulates many multinational companies, especially Jubilee and Sanlam, which gives them the opportunity to share their experience with their counterparts with whom they operate.

Does that mean NHIF is too big for Tila to regulate?
Such views are based on a lack of understanding of what insurance entails. Regulation gives NHIFs the opportunity to reinsure. Reinsurance is an agreement between a reinsurer and an insurance company under which the insurance company transfers risk to the reinsurer and the reinsurer underwrites all or part of one or more policies issued. is. In this case, there can no longer be a company so huge that there is no way to insure it.

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