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Healthcare utilization and catastrophic health expenditure in rural Tanzania: does voluntary health insurance matter?

Authors :
Alphoncina Kagaigai
Amani Anaeli
Sverre Grepperud
Amani Thomas Mori
Source :
BMC Public Health, Vol 23, Iss 1, Pp 1-13 (2023)
Publication Year :
2023
Publisher :
BMC, 2023.

Abstract

Abstract Background Over 150 million people, mostly from low and middle-income countries (LMICs) suffer from catastrophic health expenditure (CHE) every year because of high out-of-pocket (OOP) payments. In Tanzania, OOP payments account for about a quarter of the total health expenditure. This paper compares healthcare utilization and the incidence of CHE among improved Community Health Fund (iCHF) members and non-members in central Tanzania. Methods A survey was conducted in 722 households in Bahi and Chamwino districts in Dodoma region. CHE was defined as a household health expenditure exceeding 40% of total non-food expenditure (capacity to pay). Concentration index (CI) and logistic regression were used to assess the socioeconomic inequalities in the distribution of healthcare utilization and the association between CHE and iCHF enrollment status, respectively. Results 50% of the members and 29% of the non-members utilized outpatient care in the previous month, while 19% (members) and 15% (non-members) utilized inpatient care in the previous twelve months. The degree of inequality for utilization of inpatient care was higher (insured, CI = 0.38; noninsured CI = 0.29) than for outpatient care (insured, CI = 0.09; noninsured CI = 0.16). Overall, 15% of the households experienced CHE, however, when disaggregated by enrollment status, the incidence of CHE was 13% and 15% among members and non-members, respectively. The odds of iCHF-members incurring CHE were 0.4 times less compared to non-members (OR = 0.41, 95%CI: 0.27–0.63). The key determinants of CHE were iCHF enrollment status, health status, socioeconomic status, chronic illness, and the utilization of inpatient and outpatient care. Conclusion The utilization of healthcare services was higher while the incidence of CHE was lower among households enrolled in the iCHF insurance scheme relative to those not enrolled. More studies are needed to establish the reasons for the relatively high incidence of CHE among iCHF members and the low degree of healthcare utilization among households with low socioeconomic status.

Details

Language :
English
ISSN :
14712458
Volume :
23
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Public Health
Publication Type :
Academic Journal
Accession number :
edsdoj.10285ce95446442cb87d4f68be01deb5
Document Type :
article
Full Text :
https://doi.org/10.1186/s12889-023-16509-7