Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

Eunice Nahyuha Chomi; Phares G M Mujinja; Ulrika Enemark; Kristian Hansen; Angwara Dennis Kiwara

doi:10.1186/1475-9276-13-25

Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

Eunice Nahyuha Chomi, Phares G M Mujinja, Ulrika Enemark, Kristian Hansen, Angwara Dennis Kiwara

Section of Health Services Research

20 Citations (Scopus)

Abstract

BACKGROUND: Many 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.

METHODS: Using 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.

RESULTS: Generally, 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.

CONCLUSIONS: Reducing 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.

Original language	English
Article number	25
Journal	International Journal for Equity in Health
Volume	13
ISSN	1475-9276
DOIs	https://doi.org/10.1186/1475-9276-13-25
Publication status	Published - 19 Mar 2014

Keywords

Adolescent
Adult
Child
Child, Preschool
Family Characteristics
Female
Health Care Surveys
Health Services
Health Services Accessibility
Healthcare Disparities
Humans
Infant
Insurance, Health
Male
Middle Aged
National Health Programs
Patient Acceptance of Health Care
Poverty
Tanzania
Universal Coverage
Young Adult
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/1475-9276-13-25Licence: CC BY

1475-9276-13-25Final published version, 357 KBLicence: CC BY

Cite this

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title = "Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?",

abstract = "BACKGROUND: Many 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.METHODS: Using 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.RESULTS: Generally, 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.CONCLUSIONS: Reducing 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.",

keywords = "Adolescent, Adult, Child, Child, Preschool, Family Characteristics, Female, Health Care Surveys, Health Services, Health Services Accessibility, Healthcare Disparities, Humans, Infant, Insurance, Health, Male, Middle Aged, National Health Programs, Patient Acceptance of Health Care, Poverty, Tanzania, Universal Coverage, Young Adult, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't",

author = "Chomi, {Eunice Nahyuha} and Mujinja, {Phares G M} and Ulrika Enemark and Kristian Hansen and Kiwara, {Angwara Dennis}",

year = "2014",

month = mar,

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doi = "10.1186/1475-9276-13-25",

language = "English",

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journal = "International Journal for Equity in Health",

issn = "1475-9276",

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T1 - Health care seeking behaviour and utilisation in a multiple health insurance system

T2 - does insurance affiliation matter?

AU - Chomi, Eunice Nahyuha

AU - Mujinja, Phares G M

AU - Enemark, Ulrika

AU - Hansen, Kristian

AU - Kiwara, Angwara Dennis

PY - 2014/3/19

Y1 - 2014/3/19

N2 - BACKGROUND: Many 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.METHODS: Using 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.RESULTS: Generally, 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.CONCLUSIONS: Reducing 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.

AB - BACKGROUND: Many 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.METHODS: Using 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.RESULTS: Generally, 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.CONCLUSIONS: Reducing 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.

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KW - Child, Preschool

KW - Family Characteristics

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KW - Health Services Accessibility

KW - Healthcare Disparities

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KW - Infant

KW - Insurance, Health

KW - Male

KW - Middle Aged

KW - National Health Programs

KW - Patient Acceptance of Health Care

KW - Poverty

KW - Tanzania

KW - Universal Coverage

KW - Young Adult

KW - Comparative Study

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

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DO - 10.1186/1475-9276-13-25

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C2 - 24645876

SN - 1475-9276

VL - 13

JO - International Journal for Equity in Health

JF - International Journal for Equity in Health

M1 - 25

ER -

Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

Abstract

Keywords

UN SDGs

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