Health Care Utilisation among the elderly in rural Tanzania: Does health insurance matter?
Health insurance was introduced in Tanzania in mid-1990s to reduce the burden of out-of-pocket payments thereby guarantee the availability, accessibility and affordability of health care services by the vulnerable groups, particularly the elderly. But has health insurance really contributed to it?
This research project aims using both quantitative and qualitative methods to investigate if health insurance has contributed to increase access and responsiveness of the healthcare among elderly in rural Tanzania. In addition, it plans to understand the experiences of insured elderly regarding the quality of care and the attitude of the providers in relation to the health insurance implementation.
After December 9th, 1961 when Tanzania gained her independence, the government took over the country's social and economic sectors, and became the sole provider of public services including healthcare services. However, in the period between 1970s and early 1980s Tanzania’s economy suffered a serious decline which reduced significantly the ability of the government to maintain, expand and improve the accessibility, equity and quality of health care services to the mixed segments of the population. Given this challenge, the government introduced health sector reform strategies in the early 1990s’ with the aim of improving the quality, accessibility and delivery of public health services. Starting from mid 1990s, Tanzania witnessed the introduction of health insurance (HI) as a means to redress the ever-increasing expenditures on health care, as the government could not sustain the services through taxes alone. While Community Health Fund (CHF) was introduced in 1996 to cover the population outside the formal sector, National Health Insurance Fund (NHIF) was started in 2001 for the public sector employees and later was expanded to cover the informal sector. One of the focus of health insurance is to reduce the burden of out-of-pocket payments (OOP) thereby guarantee the availability, accessibility and affordability of health care services by the vulnerable groups, particularly the elderly. Since the introduction of HI, a number of studies have been conducted to investigate the extent to which HI has benefited the population in general. However, the information that is currently available is scant and lacks specificity particularly on how HI has contributed to the access to health care by the elderly in Tanzania.
While understanding and taking on board the efforts of the government of Tanzania towards establishing universal health coverage in the near future, this study seeks to investigate the contribution of health insurance on the health care of the elderly in Tanzania by using two rural selected districts. The specific objectives are:
To analyse the contribution of health insurance to improve access to health care services by the elderly
a) To analyse the contribution of health insurance to improve access to health care services by the elderly
b) To determine the perception of the elderly on the quality of health care provided through health insurance schemes
c) To explore the implementation challenges of health insurance from the providers’ perspective
d) To explore experiences of the elderly on health care provided under health insurance schemes
This mixed method study involves the collection and analysis of quantitative and qualitative data conducted through household survey, interviews and focus group discussions in Nzega and Igunga districts. Sub-study 1 used a pre-tested household survey that was based on the WHO-SAGE questionnaire administered to insured and uninsured elderly aged 60 years and above who had used hospital services past 3 and 12 months. It aimed at analysing the contribution of health insurance on the access to health care services by elderly using logistic regression. Sub-study 2 used same method as sub-study 1 to analyse the responsiveness of health care services in Tanzania with a focus on insurance status among the elderly using quantile regression analysis. Sub-study 3 will be conducted through interviews to explore the implementation challenges of health insurance from the providers’ perspective. Sub-study 4 will be conducted through FGDs to explore experiences of the elderly on health care provided under health insurance schemes. Content analysis will be used to analyse data for sub-studies 3 and 4.
The findings of this research will contribute to the empirical literature on HI, be useful to service users and providers as well as to inform health policy making and planning in the wage of promoting the utilization of health care services in study districts and beyond.