Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
BMC Public Health. 2023 Mar 8;23(1):459. doi: 10.1186/s12889-023-15297-4.
Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers' experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.
An exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.
Three categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.
While health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.
医疗保健工作者在提供健康保险福利方面发挥着重要作用，他们在确保参保客户的服务质量和可用性、可及性以及良好的管理实践方面发挥着至关重要的作用。坦桑尼亚在 20 世纪 90 年代开始了一项政府为基础的健康保险计划。然而，没有研究专门探讨医疗保健专业人员在该国提供健康保险服务方面的经验。本研究旨在探讨坦桑尼亚农村地区医疗保健工作者提供老年人健康保险福利的经验和看法。
在坦桑尼亚中西部伊古恩加和恩扎加农村地区进行了一项探索性定性研究。对至少有三年工作经验并参与向老年人提供医疗服务或负责管理健康保险的医疗保健工作者进行了八次访谈。访谈的指导原则是一组与他们对健康保险及其有用性、福利包、支付机制、利用和服务提供的经验和看法相关的问题。采用定性内容分析方法对数据进行分析。
描述了医疗保健工作者在向居住在坦桑尼亚农村的老年人提供健康保险福利方面的经验和看法的三个类别。医疗保健工作者认为健康保险是增加老年人获得医疗保健机会的重要机制。然而，除了提供保险福利外，还存在一些挑战，例如人力资源和医疗用品短缺以及与资金报销延迟相关的运营问题。
虽然健康保险被认为是促进农村老年人获得医疗保健的重要机制，但参与者提到了一些阻碍其目的的挑战。基于这些，建议增加医疗保健劳动力和医疗中心一级医疗用品的可用性，同时扩大社区健康基金的服务覆盖范围，并改进报销程序，以实现运行良好的健康保险计划。
