Responsiveness of health care services towards the elderly in Tanzania: Does health insurance make a difference? A cross-sectional study

Abstract

Introduction Responsiveness has become an important health systems performance indicator in evaluating the ability of the health care systems to meet the expectations of the patients. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania, in order to contribute with relevant knowledge to improve the performance of the health care system among the elderly in the country. Methods A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey administered to elderly (60 +) living in Igunga and Nzega districts was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and twelve months were selected. Responsiveness was measured based on the WHO-SAGE questionnaire that included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance and socio-demographic factors.Results A total of 1453 and 744 elderly, of whom 50.1% and 63% had health insurance, used the outpatient and inpatient health services respectively. All the different domains were rated relatively high but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (-1; 95% CI: -1.45, -0.45) and inpatient (-2; 95% CI: -2.69, -1.30) care. Conclusion The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked low. Further research is necessary to reveal the reasons for the lower responsiveness among insured elderly. A continuous monitoring of the health care system responsiveness is recommended.

Health System Responsiveness and Its Associated Factors Among Outpatients in Primary Health Care Facilities, Asagirt District, NorthShewa Zone, Ethiopia, 2021: Cross Sectional Study Design

“…Despite the highest performance scores on confidentiality (71.7%), Dignity (71.7%), communication (65.2%), our result revealed a concern by clients regarding; prompt attention (waiting time) (49.2%), basic amenities (42%) and Choice (37%). These were similar to other African countries of South Africa, Nigeria, and Tanzania [31][32][33] where prompt attention and quality of basic amenities were poorly performed. Thus, the result indicated demand and supply investments and the physical structure of the units proportional to the District population.…”

“…On the contrary, a study in Nigeria [43] found that gender, educational status, and income were significantly associated with HSR. Similar to this in Tanzania [32] older age, sex, and being married were associated negatively whereas, high income and educational status were significantly associated with positive responsiveness.…”

“…Due to little evidence on the responsiveness of the health system in the primary health care settings [30], there is a need to interview patients to know their experiences with the health system [31]. However, little is known in African countries [29,32,33] particularly, in Ethiopia, there is no systematically organized study addressing health system responsiveness in a domain-based manner. It is, therefore, essential to explore information on responsiveness to improve and progress towards universal health coverage(UHC) [14].…”

Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania

“…CHF is a voluntary health insurance for rural households and their dependants and services are limited to public facilities and private accredited facilities within the district of registration. The insured elderly are entitled to free services such as consultation, prescriptions, surgical services, physiotherapy and rehabilitation services, and optical and dental health services [ 23 ].…”

“…Our own research has shown that even if HI can improve the use of healthcare among rural residents aged 60 years and older, it can also decrease the perception of responsiveness of the care [ 23 ]. In order to understand this lower responsiveness, this study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania.…”