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The introduction of "cost-sharing" in medical care: a case study in Tanzania

Sarah DEWILDE student laureate

°1977 Belgium
Licence in economical sciences, Katholieke Universiteit Leuven, Belgium, 1999

De introductie van "cost-sharing" in de gezondheidszorg: een gevalstudie in Tanzania

In human history, sharing the costs for medical care is quite a recent phenomenon. Organizational standards are not yet established ; this becomes clear by looking at the big differences which exist between developed countries and by observing the violent pro and con discussions about the reforms in the United States. It is obvious that insurance systems do not only have advantages but also disadvantages, as there are overconsumption, the increased costs for the community, redistribution over the various age and income groups and high administrative costs. It is certainly praiseworthy that Sarah Dewilde set up an original, complex and time-consuming population survey, in order to map the effect of introducing a patient's cost (non-refundable part of medical expenses); a patient's cost that would allow regular drug supply, as well as improve the quality of care. Although predictable, it is disappointing to observe that mainly the rich, also those of the surrounding villages, seem to make use of this system.
It is interesting to draw a parallel between this study and publications on the evolution of healthcare in the United States, where up to now, there is strong resistance to an insurance system like in Western European countries. In the latter, even the poorest can count on good healthcare, while the system of patient's cost allows for good quality and discourages overconsumption.