NHIF broadens service scope

DAR ES SALAAM: THE National Health Insurance Fund (NHIF) has unveiled its improved benefits package, which will broaden the scope of specialised and super-specialised surgical and diagnostic services at zonal referral facilities and the national hospital.

The new benefits package will also increase the members’ access to medicines at primary level health facilities.

According to NHIF, the areas that have been reviewed and improved in the benefits package, which will commence effectively tomorrow (March 1), include registration and consultation fees, medicinal, diagnostic, and surgical services, as well as costs of regular and specialised clinics.

NHIF Director General, Mr Bernard Konga, told journalists in Dar es Salaam yesterday that the improvements are crucial since the last review of the NHIF benefits package currently in use was done eight years ago.

He said a total of 736 medicines were reviewed based on market prices, operating costs and average profit. “This will address the challenge of members missing out on some medicines due to price challenges.”

Mr Konga noted that a total of 247 new medical drugs have been added following the addition of new medicines in the National Essential Medicines List (NEMLIT) guide, noting that the move will improve the availability of medicines to members.

“By considering changes in medicines use as defined in NEMLIT, these improvements will increase access to medicinal services at primary health facilities, such as medicines for the treatment of blood pressure and diabetes,” Mr Konga said.

Regarding surgical and diagnostic services, Mr Konga said that the costs of 311 diagnostic tests and surgical services were reviewed based on market prices in purchasing equipment and reagents, operating costs, and average profit. He said the move will help address the challenge of missing out on diagnostic and surgical services due to cost challenges.

He said that the changes have also expanded the scope in the provision of specialised and super-specialised surgical and diagnostic services at zonal referral hospitals and the national hospital.

“These improvements will increase access to cancer treatment, orthopedic surgery, and cardiac surgery not only in national hospitals but also in zonal referral hospitals, thus bringing services closer to the people,” Mr Konga added.

He said that the review on registration and consultation services has enabled doctors to work at all levels of health facilities due to the uniformity of consultation fees for doctors of corresponding cadres.

“This will enable members to access specialised and super-specialised services at various levels of health facilities, taking into account the significant investment made by the government in the health sector,” he said.

He added that the main objective of the changes in the benefits package is to curb the loopholes of fraud by some dishonest healthcare providers. Additionally, it aims to ensure that every citizen enrolls in the universal health insurance service, as mandated by the already passed legislation.

Mr Konga stated that the costs for NHIF members to join the improved benefits package remain the same, but changes will only occur in the prices of services at the healthcare facilities.

Moreover, Mr Konga stated that they are continuing to receive feedback and making further improvements. He also urged stakeholders to participate in discussions regarding areas that require further improvements.

The NHIF benefits package is a list of services and their corresponding prices provided to beneficiaries and used for payment claims for medical service providers.