Uptake of Health Insurance among Informal Sector Workers in Dar es Salaam, Tanzania

Abstract

Health insurance is a system of financing healthcare and is designed to protect individuals from high medical costs. It provides a financial safety net by covering a portion of the expenses associated with medical care. Increased healthcare costs limit access to health care services especially to poor individuals including informal sector workers. Low- and Middle-Income Countries have relied on out-of-pocket payments. In the early 1990s, Tanzania introduced health insurance to alleviate the burden of out-of-pocket payments payments and stabilize its healthcare system. The different forms of insurance were introduced and they include National Health Insurance covers 8%, Community Health Fund covers 6% and other prepayment schemes cover less than 1%. Despite these efforts, coverage remains below the 30% national target set for 2015. The main objective of the study was to determine the uptake of health insurance among informal sector workers in Dar es Salaam, Tanzania. This study involved 889 respondents and it used a mixed-method approach with convenience and purposive sampling techniques. Data were collected through questionnaires, Focus Group Discussions and key informant interviews. Regression analysis was used for analysis of quantitative data via SPSS software version 23 while qualitative data was subjected to content analysis. Results shows that 8.9 % of respondents had up-taken health insurance. Factors such as age (p<0.001, Exp (B), 95% CI, 2.009: 1.620-2.491), education (p=0.006; Exp (B), 1.589; 95% CI;1.143-2.208), income (p=<0.001; Exp(B), 1.839; 95% CI, 1.471-2.298) and membership in economic groups (p<0.001; Exp (B), .119; 95% CI, 0.437; 0.066-0.215) were associated with the uptake of health insurance (p<0.05). Health systems factors associated with uptake of health insurance were insurance policy, difficulties in accessibility of health insurance services, fragmentation of insurance schemes. The individual factors included dissatisfaction with health services and insufficient knowledge about health insurance. Qualitative results showed mistrust to insurance providers, unaffordability of insurance premiums, inaccessibility of insurance selling points as factors to accessibility of health insurance. The coping strategies reported included selling assets, support from friends and relatives and borrowing from various sources. The study conclude that the uptake level of health insurance among the informal sector workers is low and it contributes to catastrophic health expenditure due to the out-of-pocket expenditures when accessing health services. The barriers to accessibility of health insurance are multifaceted and they hinder the uptake of health insurance and they require policy interventions. The study recommend that the ministry of health and insurance providers should address the low uptake of health insurance in order to improve public health outcomes, reducing health inequities. Strengthening of public healthcare systems and establishment of comprehensive community-based health insurance schemes will ensure access to health services by lowering the reliance on coping strategies to finance healthcare services