Tani Kassimu, Osetinsky Brianna, Mtenga Sally, Fink Günther, Tediosi Fabrizio
Ifakara Health Institute, Dar es Salaam, Tanzania.
Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
Health Policy Open. 2024 Sep 29;7:100130. doi: 10.1016/j.hpopen.2024.100130. eCollection 2024 Dec 15.
Globally, achieving universal health coverage remains significant challenge. Health insurance coverage in low- and middle-income countries is still low with only a few African countries managed to reach 50% coverage. This study aimed to investigate the factors influencing patients' willingness to pay (WTP) for medication and various versions of the improved Community Health Insurance Fund (iCHF) in Tanzania. A facility-based cross-sectional study was conducted in all hospitals, health centres, and eight randomly sampled dispensaries, sampling participant from the queue, one out of every three patient based on their order of entry into consultation room, and interviewed 1,748 patients in Kilombero and Same districts in Tanzania. We used multi-stage Contingent Valuation Methods exploring data collected during client exit interviews. We employed a random utility model and estimated WTP through an ordered logit model. The independent variables were; patient's gender, age, marital status, education, employment status, Non-Communicable Disease (NCD) status, health insurance status, and the type of healthcare facility level. Our findings revealed that most patients exhibited a WTP of an amount equivalent to the current iCHF premiums and would also be willing to pay for an augmented iCHF premium inclusive of additional medication coverage. Upon adjusting for demographic characteristics, we observed that patients enrolled in an insurance program or benefiting from user fee waivers demonstrated a lower WTP for medication, while those with non-communicable diseases (NCDs) and seeking care in private facilities exhibited a higher WTP. Furthermore, patients with a secondary education level or above generally displayed higher WTP for premiums. Conversely, patients enrolled in private insurance and availing user fee waivers, along with those accessing care in public facilities, demonstrated a lowered WTP for iCHF premiums. These results highlight the need for targeted interventions to address systemic deficiencies and improve access to medicines. Our conclusions is that policies considering NCD status, education levels and income status are important when designing health insurance schemes for the informal sector in Tanzania, with the goal of increasing uptake of CHF.
在全球范围内，实现全民健康覆盖仍然是一项重大挑战。低收入和中等收入国家的医疗保险覆盖率仍然很低，只有少数非洲国家达到了50%的覆盖率。本研究旨在调查影响坦桑尼亚患者为药物支付意愿（WTP）以及各种版本的改良社区健康保险基金（iCHF）的因素。在坦桑尼亚的所有医院、健康中心和八个随机抽取的诊所进行了一项基于机构的横断面研究，从排队的患者中抽样，每三名患者中按进入诊室的顺序抽取一名，并对基洛梅罗和萨梅地区的1748名患者进行了访谈。我们使用多阶段条件价值评估方法，探索在客户出院访谈期间收集的数据。我们采用随机效用模型，并通过有序logit模型估计支付意愿。自变量包括：患者的性别、年龄、婚姻状况、教育程度、就业状况、非传染性疾病（NCD）状况、健康保险状况以及医疗设施级别类型。我们的研究结果显示，大多数患者表现出的支付意愿相当于当前iCHF保费的金额，并且也愿意支付包含额外药物覆盖范围的增加后的iCHF保费。在调整人口统计学特征后，我们观察到参加保险计划或受益于费用减免的患者对药物的支付意愿较低，而患有非传染性疾病（NCDs）并在私立医疗机构就诊的患者支付意愿较高。此外，受过中等教育或以上教育的患者通常对保费表现出更高的支付意愿。相反，参加私人保险并享受费用减免的患者，以及在公共设施就诊的患者，对iCHF保费的支付意愿较低。这些结果凸显了针对性干预措施以解决系统性缺陷和改善药品可及性的必要性。我们的结论是，在为坦桑尼亚非正规部门设计健康保险计划时，考虑非传染性疾病状况、教育水平和收入状况的政策很重要，目标是提高社区健康保险（CHF）的参保率。
