Does Household Perceptions Influence Enrolment Decisions into Community-Based Health Insurance Schemes in Tanzania?

Background: Several countries including Tanzania, have established voluntary non-profit insurance schemes, commonly known as community-based health insurance schemes (CBHIs), that typically target rural populations and the informal sector. This paper considers the importance of household perceptions towards a CBHIs in Tanzania and their role in explaining the enrolment decision of households. Methods: This is a cross-sectional household survey that involves 722 households located in Bahi and Chamwino districts in Dodoma region. A three-stage sampling procedure was used, and the data were analyzed using both factor analysis (FA) and principal component analysis (PCA). Statistical tests such as Bartlett’s test of sphericity, Kaiser-Meyer-Olkin (KMO) for sampling adequacy, and the Cronbach’s alpha to measure internal consistency and scale reliability were performed to examine the suitability of the data for PCA and FA. Finally, multivariate logistic regressions were run to determine the associations between the identified factors and the insurance enrolment status. Results: PCA identified 7 perception factors while FA identified 4 factors. The quality of healthcare services, preferences (social beliefs), and accessibility to insurance scheme administration (convenience) were the common most important factors identified by the two methods. Multivariate logistic regressions showed that the factors identified from the two methods differed somewhat in importance when considered as independent predictors of the enrollment status. The most important perception factors in terms of strength of association (odds ratio) and statistical significance were accessibility to insurance scheme administration (convenience), preferences (beliefs), and the quality of health care services. Age and income were the only demographic characteristics that were significant. Conclusion: Household perceptions influence households’ decisions to enroll in CBHIs. Policymakers should recognize and consider the role of perceptions when designing policies that aim to increase the enrolment into CBHIs.