Analysis on the equity differential on household healthcare financing in developing countries: empirical evidence from Tanzania, East Africa

Abstract

Background Achieving equity in healthcare services has been a global priority. According to the literature, a slew of initiatives aimed at increasing household equity in healthcare financing have exacerbated the problem, making it hard for most developing countries to understand the real cause of the problem. Method The non-experimental research design has been used to explore the Tanzania Panel Survey (NPS) data 2019/2020, to investigate equity differential in household healthcare financing in Tanzania by the use of conventional instrumental variable methods of Two-stage and Three-stage least square methods Results Despite the global agenda of universal health coverage, this paper reveals that 86 percent of Tanzania lacks health insurance with a high degree of inequitable distribution of health facilities as 71.54 percent of the population is in rural areas, yet these areas have poor health systems compared to urban ones. These disparities increase pressure on household healthcare financing and widen the inequity and equality gaps simultaneously. Additionally, a household's income, education, health care waivers, out-of-pocket expenditure, and user fees have been found to have a significant impact on household equity in healthcare financing. Conclusion To reverse the situation and increase equity in household healthcare financing in most developing countries, this paper suggests that an adequate pooling system should be used to allow more people to be covered by medical prepayment programs, and the donor-funded programs in developing countries should focus on health sector infrastructure development and not the capacity building.

Equity in the public social healthcare protection in Tanzania: does it matter on household healthcare financing?

“…This paper combines data from questions on coverage under NHIS with demographic and socio-economic indicators to analyze equity on the health insurance coverage in Tanzania and its effects on the household healthcare financing. The choice of the dataset is based on the fact that Tanzania is currently heading towards the end of its 25 years development vision (2000 – 2025) therefore these data (NPS 2021) will have the most accurate information heading 2025 making our estimates more realistic for the twenty-five years reflections [ 5 , 18 ].…”

“…Social health care protection is vital for the increase of health care utilization, decline in mortality and reduction of the household socioeconomic burden as a result of catastrophic health care spending [ 1 – 3 ]. Additionally, at times where countries are struggling to ensure health services are available to all people at lower costs and meet the sustainable development targets, the use of public health protection is unavoidable for major two purposes of reducing negative effects of excessive household health care financing and increase access to health care [ 4 , 5 ]. Despite of potential initiatives put forward by governments in developed and developing countries towards relaxation of household pressure on the rising costs of health care through the establishment of more affordable public social health insurance schemes, there have been greater variations due to inequity in terms of subscriptions, accessibility and financial limitations across households and regions within countries [ 6 – 8 ].…”

“…Kitole et al [ 5 ] acknowledges that “several studies have been made to analyze equity and equality towards access to healthcare globally and locally [ 9 ]. Despite these studies been a benchmark for the future studies they have had different and contradictory results which increases debates on whether issues of equity are important or can be achieved on health given that households and governments across the globe have different characteristics and level of development.” In this situation achieving equity in health care is a nightmare for most of the developing countries which are faced by deficit budget and heavily depends on donor and external assistance to finance health sector including Tanzania [ 5 ].…”

“…Most of the urban population in Tanzania are covered with health insurance compared to those in rural areas despite most of the health insurances schemes in these areas being available at low costs compared to those in urban counterparts [ 5 , 9 ]. This makes more private and newly established health insurance schemes to pile up in urban areas due to the good and competitive market.…”

“…In this regard, there is a need for an equity analysis to identify major socioeconomic and institutional characteristics that may lead to the expulsion of certain groups of people from accessing health care services which this will be a stepping stone towards realization of the long-awaited dream of equity in health. Uniqueness of the current study is brought by the fact that it examines simultaneously effects equity on the health insurance coverage and its effects on household health care financing, unlike many studies which have examine these two separately [ 5 , 9 , 14 ] and ignoring the fact government efforts in moving towards universal health coverage can widen health inequity across households if the two will not be properly addressed.…”