Responsiveness of The Health Care System Towards The Elderly In Tanzania: Does Health Insurance Make a Difference? A cross Sectional Study

Abstract Background Responsiveness has become an important tool in evaluating the ability of the health care systems to meet the expectations of the patients. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania, in order to contribute with relevant knowledge to improve the performance of health insurance among the elderly in the country. Methods This is across sectional study. We used a pre-tested household survey administered to elderly (60 years +) living in Igunga and Nzega districts. Participants with and without health insurance attending outpatient and inpatient health care services in the past three and twelve months were selected. Responsiveness was based on the WHO-SAGE questionnaire that included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to explore the specific association of the responsiveness index with health insurance and socio-demographic factors. Results A total of 1453 and 744 elderly, of whom 50.1% and 63% had health insurance, used the outpatient and inpatient health services respectively. All the different domains were rated relatively high but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (-1; 95% CI: -1.45, -0.45) and inpatient (-2; 95% CI: -2.69, -1.30) care. Conclusion The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked low. Further research is necessary to reveal the reasons for the lower responsiveness among insured elderly. A continuous monitoring of the health care system responsiveness is recommended.