Non-communicable diseases reimbursement trends and predictors towards universal health insurance: a case of the national health insurance fund in Tanzania.

Abstract

ABSTRACT Background: Non-communicable diseases (NCDs) account for 74% of global deaths annually, among which cardiovascular diseases account for 13.72%. In Tanzania, the burden of NCD has been on the rise and it is estimated that hypertension has a prevalence of 26% and a prevalence of 9% and contributes to over one-third of all deaths (34%). Although the prevalence of NCDs is increasing the financial impact of these NCDs on the National Health Insurance Fund (NHIF) has not been fully explored. Objective: The main objective is to assess distributions, and trends of the major NCDs and to determine NCD reimbursement predictors using from January 2021 to December 2023. Method: A cross-sectional study design that used quantitative approaches to analyze secondary claims data from the NHIF database using the ICD-10. The data were analyzed using R Statistical software. Descriptive statistics were used to report and summarize the distributions, and reimbursement trends of the major NCDs, and multivariable log-linear regression analysis was deployed to determine the predictors for NCD reimbursement to NHIF. Findings: We found that females and the old age group (50-65, 65, and above) accounted for most NCD reimbursement, with NCD-related claims increasing from 1,293,668 claims in 2021 to 8,748,323 claims in 2023. Cardiovascular and diabetes-related claims were the highest followed by cancers and chronic renal disease. Most claims originated from private facilities 40% in 2023 followed by Government facilities 32% in 2023. The overall NCD reimbursement rose from TZS 220.1 billion (2022) to TZS 235.8 billion (2023), whereby cancers related claims having the highest average reimbursement per patient from TZS 1,110,464 to TZS 1,166,545 making the most expensive NCD to manage. We identified that NCD types, age group, sex, facility level, and type of facility ownership were predictors of NCD reimbursement. Conclusion and Recommendation: This study highlights that elderly individuals and females make up a significant portion of NHIF beneficiaries with NCD claims. NCD reimbursements by the NHIF have risen with cardiovascular diseases dominating the claims, while cancers and chronic renal diseases are the most costly to manage. NCD vi reimbursements correlate with identified predictors. Notably, private and zonal hospitals are associated with higher reimbursements. The NHIF should enforce effective referral systems and prioritize prevention and NCD treatment at primary and public facilities, which can deliver quality care at lower costs