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

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• 作者：Eunice Nahyuha Chomi (1) (2)
  Phares GM Mujinja (1)
  Ulrika Enemark (2)
  Kristian Hansen (3)
  Angwara Dennis Kiwara (1)
  
  1. Muhimbili University of Health and Allied Sciences ; Dar-es-Salaam ; Tanzania
  2. Aarhus University ; Aarhus ; Denmark
  3. London School of Hygiene and Tropical Medicine ; London ; UK
  
• 关键词：Health insurance ; Health care utilisation ; Health seeking behaviour ; Equity
• 刊名：International Journal for Equity in Health
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：13
• 期：1
• 全文大小：227 KB
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• 刊物主题：Public Health; Development Economics; Quality of Life Research; Social Policy;
• 出版者：BioMed Central
• ISSN：1475-9276

文摘

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.