French social security and North-South cooperation: Installing a health insurance program in Tanzania

Aims: To describe the process used by French experts for developing the entire scope of healthcare benefits to be covered by the health insurance fund. This procedure was presented to the high-level management of the National social security fund in Dar es-Salaam in June 2003. Method: This study was undertaken in Tanzania in June 2003 and modeled the cost of health insurance in the National social security fund (its ambulatory component exclusively) by using all the local demographic, epidemiologic and economic data available. Results: Since 1993, Tanzania has transferred the cost of healthcare from the state towards some of the beneficiaries of the public medical sector. The National social security fund, a mandatory public agency of social security, has decided to implement a health insurance program. According to our model and our assumptions, the cost of the ambulatory component of health insurance would utilize approximately 20 to 60 % of available resources. Conclusion: The National social security fund has to make clear choices concerning the scope of healthcare benefits it wants to cover: only outpatient care or both outpatient and inpatient coverage? Capitation or fee for service? The National social security fund also needs to develop reliable databases in order to better understand the population it covers and the behavior of those who use the care. By instituting health insurance, the National social security fund will help break the vicious circle of "disease-poverty" and contribute to improving the level of Tanzania’s development.