Abstract
BackgroundHealth insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania.MethodAn explanatory qualitative study was conducted in the rural districts of Igunga and Nzega, located in western-central Tanzania. Eight focus group discussions were carried out with 78 insured and uninsured elderly men and women who were purposely selected because they were 60 years of age or older and had utilised healthcare services in the past 12 months prior to the study. The interview questions were inspired by the domains of health systems’ responsiveness. Qualitative content analysis was used to analyse the data.ResultsElderly participants appreciated that HI had facilitated the access to healthcare and protected them from certain costs. But they also complained that HI had failed to provide equitable access due to limited service benefits and restricted use of services within schemes. Although elderly perspectives varied widely across the domains of responsiveness, insured individuals generally expressed dissatisfaction with their healthcare.ConclusionsThe national health insurance policy should be revisited in order to improve its implementation and expand the scope of service coverage. Strategic decisions are required to improve the healthcare infrastructure, increase the number of healthcare workers, ensure the availability of medicines and testing facilities at healthcare centers, and reduce long administrative procedures related to HI. A continuous training plan for healthcare workers focused on patients´ communication skills and care rights is highly recommended.
Highlights
The world has witnessed a rapid increase in population ageing, in low and middle-income countries (LMICs)
Elderly participants appreciated that Health insurance (HI) had facilitated the access to healthcare and protected them from certain costs
A continuous training plan for healthcare workers focused on patientscommunication skills and care rights is highly recommended
Summary
The world has witnessed a rapid increase in population ageing, in low and middle-income countries (LMICs). While the average enrolment of CHF varies across districts, the 30 % coverage rate that was expected by the year 2015 has not yet been achieved This might have been caused by diverse factors such as the voluntary nature of the schemes, a limited benefit package, and restricted use at local primary and secondary health facilities [10]. In addition to these insurance schemes, elderly people, considered to be poor to join the CHF, can apply to district social welfare officer for an exemption of costs related to health care at the public facilities within the district of residence [9].
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