Association between health insurance status and healthcare services utilization among rural population in Hai District Northern Tanzania

Abstract

Nearly half of the population globally is reported to be unable to access to basic health services. One of the key reasons demonstrated to influence is the burden of healthcare costs. Access to basic quality healthcare services remains limited across Africa, with fewer than half of the population being able to obtain such services. The situation is even worse in Sub-Saharan Africa (SSA) where coverage is estimated to be less than 42.56%. Health insurance has been identified by WHO as a mechanism to alleviate financial hardship and improve utilization of healthcare services. There are limited studies exploring on association of insurance types and utilization of healthcare services. Hence, this study aims to determine the association between health insurance status and healthcare services utilization comparing between voluntary and compulsory health insurance types. A cross-sectional study was conducted using multistage purposive sampling among 494 household. Respondent was considered as household head who was either a father, mother or any adult person depending on who was available and was able to provide required information at the time of collection. The dependent variable was healthcare services utilization and the key independent variable was insurance status. Descriptive statistics summarized participant characteristics using frequencies, percentages, means and standard deviation. A Chi-square test of independence was first performed then bivariable logistic regression with p < 0.2 being significant calculated crude odds ratio. Lastly, multivariable logistic regression was used to assess for potential confounders by calculating adjusted odds ratio and p-value of < 0.05 was considered statistically significant. Of 494 participants (mean age 41.4 ± 15.4 years), 26.9% reported healthcare service utilization in the past 12 months, with outpatient care (19.2%) more common than inpatient care (7.7%). Only 18.2% of participants had health insurance, and utilization was significantly higher among the insured (43.3%) than the uninsured (23.3%; p < 0.001). Multivariable logistic regression revealed that health insurance coverage (AOR = 2.24; 95% CI: 1.22–4.11; p = 0.010), marital status (married: AOR = 2.74; 95% CI: 1.41–5.30; p = 0.003), higher income (> TZS 500,000: AOR = 4.27; 95% CI: 2.03–8.99; p < 0.001), recent illness (AOR = 2.91; 95% CI: 1.80–4.73; p < 0.001), and chronic medication use (AOR = 3.38; 95% CI: 1.77–6.48; p < 0.001) were significantly associated with healthcare services utilization. Other socio-demographic and economic factors were not significantly associated with healthcare service utilization after adjustment. Utilization of healthcare services among the rural population remains relatively low. The findings underscore that; adequate financial protection and socio-economic support are necessary for many rural residents to have access to timely and necessary healthcare services. Therefore, Governmental insurance authority such as NHIF, NSSF and iCHF as well as non-governmental organizations such as strategies, jubilee and AAR should expand health insurance coverage. The current Tanzanian Governmental policy of implementing universal health insurance is very essential to reduce health disparities in Tanzania and similar settings leading to universal health coverage. To achieve this, government should expand and strengthen enrollment programs into health insurance schemes by providing appropriate education and mobilizing fund particularly to support the vulnerable rural community which is economically disadvantaged.