Abstract
BackgroundMany countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members of the Community Health Fund, the National Health Insurance Fund and non-members in two districts in Tanzania.MethodsUsing household survey data collected in 2011 with a sample of 3290 individuals, the study uses a multinomial logit model to examine the influence of predisposing, enabling and need characteristics on the probability of seeking care and choice of provider.ResultsGenerally, health insurance is found to increase the probability of seeking care and reduce delays. However, the probability, timing of seeking care and choice of provider varies across the CHF and NHIF members.ConclusionsReducing fragmentation is necessary to provide opportunities for redistribution and to promote equity in utilisation of health services. Improvement in the delivery of services is crucial for achievement of improved access and financial protection and for increased enrolment into the CHF, which is essential for broadening redistribution and cross-subsidisation to promote equity.
Highlights
Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups
This paper examined the effects of fragmented risk pooling on health care seeking behaviour and utilisation of Community Health Fund (CHF) and National Health Insurance Fund (NHIF) members and non-members
Lack of money to pay for treatment is a significant barrier to seeking care for non-members but not for CHF and NHIF members, since this was the main reason for delays in seeking care or not seeking care at all reported by non-members
Summary
Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. Existence of multiple health insurance funds may cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. When mechanisms to promote cross-subsidies across funds exist within the health insurance system, the risk pools are referred to as integrated Without such mechanisms the risk pools are referred to as fragmented [1]. The differential revenue raising capacities and benefit packages offered by the various insurance funds in a fragmented system are likely to result in varying degrees of access, health care seeking behaviour and utilisation of health services [1,4].
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