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

Abstract

Background Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients’ expectations. 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 and to explore the association of health insurance (HI) with responsiveness in this population. Methods A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) 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 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which 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 adjusted for sociodemographic factors. Results A total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly 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 poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.

Unmet Needs of Healthcare Services and Associated Factors among a Cohort of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design

“…Generally, transport infrastructure in many low-resource settings is underdeveloped and older people have to rely on public or shared transport, which limits their access to health services. 50 Other studies have also shown that where there are poor transport systems or lack of it, older persons particularly in rural areas of Ghana and those with disabilities find it difficult to access the needed healthcare. 1 , 3 , 50 Considering the concept of health environment, there is a relationship between the built environment (which include transport facilities) and the health of older adults.…”

“… 50 Other studies have also shown that where there are poor transport systems or lack of it, older persons particularly in rural areas of Ghana and those with disabilities find it difficult to access the needed healthcare. 1 , 3 , 50 Considering the concept of health environment, there is a relationship between the built environment (which include transport facilities) and the health of older adults. 51 , 52 The model proposes that in dense urban settings, although distances to healthcare providers may be relatively short, there may be travel-related challenges.…”

Does Awareness Matter for the Improved Community Health Fund? Evidence from Street Vendors in Dodoma City, Tanzania

“…The available studies in the context of Tanzania have mainly examined the health insurance schemes with the experience from the elderly (Tungu, et al, 2020;Amani, et al, 2020;Amani, et al, 2021). Thus, there is a lack of evidence about the improved CHF and the enhancement of health service delivery from the perspective of street vendors in Tanzania.…”

Mediation effect of trust on willingness to pay for health insurance among co-operative members in Tanzania

“…This is not preferred as high out-of-pocket expenditures result in financial hardship, causing millions of individuals, particularly those in the informal sector, to receive incomplete cures and give up on needed health care. Also, most individuals are pushed into extreme poverty and death [ 6 , 34 , 93 ]. Any government does not desire this situation.…”

“…Any government does not desire this situation. Thus, governments worldwide have been trying to implement initiatives to reduce out-of-pocket expenditures and increase the number of individuals with health insurance [ 6 , 41 ]. One of recommended initiative involves co-opting member-based organisations such as co-operatives to supplement government initiatives to accelerate health insurance financing across populations.…”