References in the content below refer to the PBMEF Guide.
Definitions
Country has a national or social health insurance (NHI/SHI) scheme whose benefit package includes TB clinical services.
NHI/SHI: forms of health insurance that are often administered by the government or a quasi-governmental agency, funded through contribution from taxes and/or employers and employees, and cover a package of services. Community based health insurance (CBHI) schemes are usually voluntary and characterized by community members pooling funds to offset the cost of healthcare. Some countries with CBHI schemes are adjusting the model towards integration into broader NHI/SHI schemes.
For the purpose of this indicator, NHI/SHI/CBHI schemes should only be scored as being “available” if they exceed the following threshold: >50% population coverage and >2% of current health expenditure (CHE) comes from prepayment. These schemes should include diagnosis, treatment, and prevention of all forms of TB, including multidrug-resistant (MDR) TB, for all populations of the country.
This indicator is intended to measure whether a country is able to source funding for TB from an insurance scheme; countries with no insurance scheme should score “0” (even if TB care is free).
Numerator
Denominator
Ref # |
SN_TB_INSUR
(Previously SN-8B) |
Tier Level |
Core Plus Indicator
|
Category |
Sustain
|
Type |
Output
|
Unit of Measure |
Score between 0–4
|
Data Type |
Integer
|
Disaggregations |
N/A |
Reporting Level |
All Core Plus indicators should be reported at the national level.
|
Reporting Frequency |
This indicator should be reported on an annual basis at a minimum.
|
The data sources for this indicator may include a country’s NHI/SHI Policy and Benefits Package. Key informant interviews with the National TB Program (NTP) may also be conducted if further review is needed.
High medical costs and lack of health insurance can contribute to catastrophic out of pocket expenditure as a result of active TB disease. Inclusion of clinical TB services (i.e., diagnostic and treatment services) in NHI/SHI schemes should help to reduce out of pocket costs for people on TB treatment.
Medical care is necessary and essential in the course of people’s lives, and care is increasingly expensive worldwide. However, health insurance covers all or some costs of care and protects patients or clients from very high expenses that may prevent them from seeking medical care. Studies show that insured people are more likely than uninsured people to have regular curative health care and to have routine preventive care. Those people without health insurance coverage often delay seeking needed care and find services difficult to afford.
This indicator complements the following indicators to provide a more complete picture of social support protections and health insurance schemes that support people with TB:
- Country has social protection schemes available for TB patients
- Percent of people with TB covered by insurance
- Percent of people on DS-TB treatment who receive TB care package
- Percent of people on DR-TB treatment who receive TB care package
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