NATIONAL HEALTH INSURANCE FUND NBAA SEMINAR ON RETIREMENT AND SOCIAL SECURITY Roles of Pension and Medical Insurance Schemes in Tanzania: Challenges

Transcription

1 NATIONAL HEALTH INSURANCE FUND NBAA SEMINAR ON RETIREMENT AND SOCIAL SECURITY Roles of Pension and Medical Insurance Schemes in Tanzania: Challenges and Prospects. Presented by Raphael T. Mwamoto Director of Operations (NHIF) Monday, February 22,

2 1.0 Introduction 1.1 SETUP OF SOCIAL SECURITY IN TANZANIA In Tanzania formal security system is made up of Pension Schemesand Medical Insurance schemes. These SSIs are mainly contributory and by far covers the formal sector. Recent institutional reforms have allowed the informal sector to also enroll so that they could reap similar benefits as for compulsory contributors.

3 Introduction Cont. In Tanzania, SSIs include:- Government Employees Provident Fund/ GEPF Retirement Fund; Local Authorities Pensions Fund (LAPF); National Social Security Fund (NSSF); Parastatal Pensions Fund (PPF); and Public Service Pensions Fund (PSPF) Zanzibar Social Security Fund (ZSSF); National Health Insurance Fund (NHIF)

4 Introduction Cont SS Legislations These SSIs have different laws of their establishment namely:- The National Social security Fund operates under the National Social Security Fund Act of 1997 to replace the National Provident Fund; The Parastatals Pensions Fund operates under the PPF Fund Act of 2002;

5 SS Laws cont The Public Service Pensions Fund operates under the Public Service Retirement Benefits Act of 1999; The Local Authorities Pensions Fund operates under the Local Authorities Pensions Fund Act of 2006; The GEPF Retirements Benefits Fund operates under the GEPF Retirements Benefits Act of 2013 The National Health Insurance Fund operates under the National Health Insurance Fund Act of 1999

6 Introduction Cont It is the above fragmentation in the Tanzanian SS system that called for inception of:- Social Security Policy (2003) SSRA (2008) The above instruments were meant to coordinate the industry, create a level ground and provide rules of thegame.

7 Introduction cont Rationale for Regulation Anecdotal evidence suggests that the legal and regulatory framework of the SS industry was intended to, inter alia:- i. Widen the scope and coverage of social security, ii. Harmonize social security to eliminate fragmentation iii. Rationalise contribution rates and benefit structures;

8 Rationale for Regulation iv. Reduce poverty through improved quality and quantity of benefits offered; v. Institute a mechanism for good governance and sustainability of social security institutions vi. Establish a social security structure that is consistent with the ILO standards but with due regard to the domestic settings; and vii. Ensure more transparency and involvement of social partners in decision making with respect to social security institutions.

9 2.0 Health Insurance Business in Tanzania A. Private Health Insurance AAR MEDEX JUBILEE MOMENTUM PHOENIX RESOLUTION HEALTH STRATEGIES Characteristics:- Risk adjusted premiums Small pools

10 Set up of HI Platform B. Community-Based Health Insurance Schemes Managed by district councils, CHF currently being implemented in 145/167 councils. NHIF administers and promotes these Funds. Other schemes are area-based mutual-health arrangements like the: Umoja wa Matibabu wa SektaIsiyo Rasmi Tanzania (UMASITA), Vikundi vya Biashara Ndogondogo (VIBINDO), etc.

11 HI Platform C. Social Health Insurance Schemes: These are ünhif ünssf-shib + PENSION Characteristics:- i. Social security principles ii. Equity iii. Solidarity iv. Large pools/principle of large numbers v. Income and risk cross-subsidization

12 National Social Health Protection Framework PRIVATE/INDIVIDUAL ARRANGEMENTS (Subscription to PIC) OCCUPATION PLANS (Arrangements by Employers) MICRO INSURANCE & MUTUAL USER FEES SOCIAL HEALTH BENEFITS-SHIB (NSSF) COMMUNITY HEALTH PROGRAM CHF COUNCILS (OUT OF 167) COMPULSORY NHIF PROGRAMS PUBLIC HEALTH PROGRAMS National Health Financing Workshop 12

13 Health Insurance Coverage: Coverage Statistics Statistics of Tanzanian CitizenCovered by 2015 Scheme Establishment Act Effective Date (Health) Number of members Number of beneficiaries % of pop covered NHIF No. 8/ ,143 3,144, CHF No. 1/ ,879 5,585, NSSF/SHIB No. 36/1964 & No 28/ , Private 120, Insurance Micro Insurance 41, Total 8,942,

14 A Case of NHIF NHIF is compulsory for the public sector, Voluntary for private and informal sectors. Inception of the Fund was a result of socioeconomic reforms in the 1980s and early 1990s.

15 CATEGORY OF MEMBERS UNDER NHIF/CHF Category Nature Contribution mode Remarks Public Employees Non Public Employees Those with employer/employee relationship Those with employer/employee relationship Earnings related (6% shared equally ) Earnings related (6% shared equally ) Include government employees, local government authorities, agencies, parastatals, etc Beneficiaries are Principal member, spouse and four dependants Private employees Beneficiaries are Principal member, spouse and four dependants Those who their income is difficult to Self employed (Private Those who are self determine Flat rate Individual) employed Beneficiaries are Principal member, spouse and four dependants Students Higher learning Institutions Flat rate Beneficiary is the principal member only Clergy Religious leaders Flat rate Number of beneficiaries depend on a denomination Councilors Political leaders Flat rate Membership cease after their tenure of leadership Micro-insurance groups Individual members within a group Flat rate Contribution rate take into consideration Police force Employer/employee Earning related (6.25% risk factor of this group relationship paid by the Gvt) Beneficiaries are Principal member, spouse and four dependants Retirees Those who were members Based on the credits of the Fund ( min 120 months) Covers principal member and Spouse Those in rural and urban Community Monday, February members22, 2016 areas under Local Rate of premium depend on ability to pay of Flat rate 15 Government Authorities the respective council

16 MEMBERSHIP SIZE AND POPULATION COVERAGE Insured persons and Fund s beneficiaries kept on increasing since inception of the Fund Membership size has grown from 164,708 in 2001/02 to 626,143 in 2014/15 which is four times growth Membership size > 626,143, corresponding to 3,144,115 beneficiaries CHF registered > 930,879 households corresponding to 5,585,274 beneficiaries. NHIF & CHF > 8,729,389 beneficiaries, covering 20% of Tanzania population (NHIF covers 7.2% and CHF cover 12.8%). Monday, February 22,

17 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000, ,000 - TREND OF PRINCIPAL MEMBERS AND BENEFICIARIES FROM TO Principal Members Beneficiaries Monday, February 22,

18 BENEFIT PACKAGE GROWTH /09 Retirees Orthopedic Appliances Optical Services Pharmaceutical Services Specialized Surgery Major Surgery Minor Surgery Procedures Outpatient Care Services Registration/Co nsultation Fee 2001/ / / / / / /

19 180, TREND OF FUNDS APPLICATION FROM TO , , , , , , , , Benefit Payments Administrative Expenses Other Expenditure Monday, February 22,

20 3.0 ROLES OF SSSs SSSs not only help to improve the life standards of citizens in terms of income replacement in the eventuality of a contingency but also spur economic growth.

21 Roles of SSSs Hedges against escalating medical costs to the household (inflation rate of medical services is the highest), Improves health services infrastructures

22 NHIF Investments in health Infrastructure Centre of Medical Excellence in Dodoma (CME), Benjamin Mkapa Modern Medical Centre at the University of Dodoma, Twin Tower Block for Muhimbili Orthopedics Institute (MOI), Medical Equipments and Facilities Improvement Loans (MEFI) Medicinesand MedicalConsumablesLoans Monday, February 22,

23 Roles of SSIs cont Income replacement in the event of old age, survivorship, invalidity etc. Unconventional benefits ü education benefits, ü Entrepreneurial benefits (through SACCOS)

24 Roles of SSIs cont Social economic utility üinfrastructure development (Kigamboni Bridge) üuniversity of Dodoma üaffordable Housing Estates

25 Roles of SSIs cont.. Output Impact (Goods and services). Pensioners spend the money/multiplier effect. Employment impact. Through various projects. Money market impact. FDRs, T.Bills, IPOs and hence loanable funds to commercial banks and other financial institutions.

26 Modern Medical Centre at the University Of Dodoma Monday, February 22,

27 Construction of a seven twin storey block for Muhimbili Orthopedics Institute (MOI), Monday, February 22,

28 4.0 CHALLENGES AND PROSPECTS Applause: SSRA for eliminating some of the challenges such as transferability/portability of accrued benefits and choice of schemes. However, the following challenges still haunt the SS industry:- Limited Coverage Inadequacy of benefits SS product diversification: light at the end of the tunnel

29 Challenges cont.. ILO Convention 102: exotic prescription of SS benefits ( are the benefits still relevant in our context?) or product re-engineering necessary? Voluntary vs mandatory designs. Limited investment opportunities Fragmentation: what Ministry is appropriate?? MoF or MoL?

30 5.0 Prospects Social assistance programme/cash transfers: SSRA/Government working on this. Universal health coverage: the legal framework is underway by the MoH Informal sector coverage on the rise though at low pace and chronic drop outs.

31 END NDAGA FIJO Ahsanteni Sana Thank you very much 31