Assessment of equity in healthcare financing and benefits distribution in Tanzania: a cross-sectional study protocol

Binyaruka, Peter; Kuwawenaruwa, August; Ally, Mariam; Piatti, Moritz; Mtei, Gemini

doi:10.1136/bmjopen-2020-045807

Cited by 6 publications

(11 citation statements)

References 43 publications

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“…The OOPE disturbs the equality in the context of health care spending and thereby contributes to a rise in poverty. 8,21 The impoverished section banks heavily on the quality of public health facilities. 24 Quality of health care is characterised by diverse individual-level factors viz.…”

Section: Out-of-pocket Expenditurementioning

confidence: 99%

“…Inequality (8) specifies patients in locality i ∈ I can seek care from a public facility of type k ∈ K at location j ∈ J 1 only if such a facility exists there.…”

Section: Reconfigurationmentioning

confidence: 99%

“…6 In developing countries, government funding for healthcare has been both inadequate and inefficient, 7 while insurance-based financing is yet to be prevalent. 8 Therefore most patients have to pay for the services.…”

Section: Introductionmentioning

confidence: 99%

“…The three major health financing models are public finance, personal out‐of‐pocket expenses, and insurance 6 . In developing countries, government funding for healthcare has been both inadequate and inefficient, 7 while insurance‐based financing is yet to be prevalent 8 . Therefore most patients have to pay for the services.…”

Section: Introductionmentioning

confidence: 99%

“…The study is conducted on a data set containing 29 population centres, 22 existing PHCs, 13 existing CHCs, and 15 private OPDs. Demand of 29 population centres is assumed to be(197, 250,8,17,13,50,5,9,16,8,6,6,16,22,24,42,55,6,11,28,54,50,9,5,15,3,5,25,37). Capacities of PHC, CHC, and private OPD were assumed to be 50, 70, and 50 respectively.…”

mentioning

confidence: 99%

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A public‐private partnership based model for regulating out‐of‐pocket expenditures to strengthen primary care system

Kumar

2022

Health Planning & Management

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In developing countries like India, the cost of health care is largely borne by patient out‐of‐pocket payments. Recent studies have reported that patients skip public‐funded clinics providing free consultation for distant private care providers. Some of the reasons identified for such behaviour include longer waiting times, perception regarding quality of care, etc. Therefore, optimal allocation of existing and new capacity is critical for a greater public interest. This article presents a decision‐making framework towards this intent for strengthening the existing government primary healthcare network. In this article, a mixed‐integer linear programing (MILP) model is developed for optimal reconfiguration of the existing government primary healthcare network to minimise patient out‐of‐pocket expenditures (OOPE). The model involves three types of facilities: Primary Health Centre (PHC), Community Health Centre (CHC), and Private OPD (outpatient department). Implementation of the proposed model can help in reducing out‐of‐pocket expenditures. The optimization model proposed in the article is unique as it incorporates for the first time, patient out‐of‐pocket expenditure, capacity reconfiguration, and public‐private partnership decisions in the primary healthcare system. A solution algorithm is also proposed for the optimization model. The model would be useful for theory development and also in policy‐making.

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Section: Out-of-pocket Expenditurementioning

confidence: 99%

“…Inequality (8) specifies patients in locality i ∈ I can seek care from a public facility of type k ∈ K at location j ∈ J 1 only if such a facility exists there.…”

Section: Reconfigurationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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A public‐private partnership based model for regulating out‐of‐pocket expenditures to strengthen primary care system

Kumar

2022

Health Planning & Management

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

Kagaigai,

Anaeli,

Grepperud

et al. 2023

BMC Public Health

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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.

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Equity in the public social healthcare protection in Tanzania: does it matter on household healthcare financing?

Kitole

Lihawa

Mkuna

2023

Int J Equity Health

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Efforts to promote equity in healthcare involve implementing policies and programs that address the root causes of healthcare disparities and promote equal access to care. One such program is the public social healthcare protection schemes. However, like many other developing countries, Tanzania has low health insurance coverage, hindering its efforts to achieve universal health coverage. This study examines the role of equity in public social healthcare protection and its effects on household healthcare financing in Tanzania. The study used secondary data collected from the National Bureau of Statistics' National Panel Survey 2020/21 and stratified households based on their place of residence (rural vs. urban). Moreover, the logit regression model, ordered logit, and the endogenous switching regression model were used to provide counterfactual estimates without selection bias and endogeneity problems. The results showed greater variations in social health protection across rural and urban households, increasing disparities in health outcomes between these areas. Rural residents are the most vulnerable groups. Furthermore, education, income, and direct healthcare costs significantly influence equity in healthcare financing and the ability of households to benefit from public social healthcare protection schemes. To achieve equity in healthcare in rural and urban areas, developing countries need to increase investment in health sector by reducing the cost of healthcare, which will significantly reduce household healthcare financing. Furthermore, the study recommends that social health protection is an essential strategy for improving fair access to quality healthcare by removing differences across households and promoting equality in utilizing healthcare services.

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Assessment of equity in healthcare financing and benefits distribution in Tanzania: a cross-sectional study protocol

Cited by 6 publications

References 43 publications

A public‐private partnership based model for regulating out‐of‐pocket expenditures to strengthen primary care system

A public‐private partnership based model for regulating out‐of‐pocket expenditures to strengthen primary care system

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

Equity in the public social healthcare protection in Tanzania: does it matter on household healthcare financing?

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