Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study

(2023) 23:459 Amani et al. BMC Public Health https://doi.org/10.1186/s12889-023-15297-4 BMC Public Health Open Access RESEARCH Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study Paul Joseph Amani1,2*, Miguel San Sebastian2, Anna‑Karin Hurtig2, Angwara Denis Kiwara3 and Isabel Goicolea2 Abstract Background 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. Methods 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 experi‑ ence 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. Results Three categories were developed that describe healthcare workers´ experiences and perceptions of deliver‑ ing the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insur‑ ance 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. Conclusion 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 recom‑ mended to achieve a well-functioning health insurance scheme. Keywords Healthcare workers, Qualitative, Elderly, Health insurance, Rural, Tanzania *Correspondence: Paul Joseph Amani Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Amani et al. BMC Public Health (2023) 23:459 Background Healthcare systems in low- and middle-income countries have to adapt to the needs of a rapidly increasing elderly population [1]. In these countries, the majority of this group is commonly socio-economically vulnerable, has poorer health that requires more healthcare visits, and reside in rural areas where healthcare infrastructure is more limited than in urban settings [2]. In order to address these challenges, a series of healthcare reforms, often including public health insurance (HI) schemes, has been underway in the last two decades, with the aim of enhancing access to care and promoting economic protection to the elderly [3]. Government-based HI has been established as a risksharing mechanism, particularly in Sub-Saharan Africa (SSA), to finance healthcare, minimise social inequality, and enable access to care, particularly to socially disadvantaged populations [4–7]. Overall, experience has shown that HI not only increases access to and utilisation of healthcare but also extends financial protection to an economically vulnerable population, such as the elderly [8]. The reported success behind HI strongly supports the goal of achieving universal health coverage, as it focuses on creating a healthcare system that is able to provide equitable access to healthcare for all [9]. Nevertheless, HI has also been criticised for not being able to meet the expectations of the insured regarding quality of care, to reduce waiting times, and to financially protect vulnerable population groups equally [10–12]. Healthcare workers play an important part in the delivery of HI benefits, and their role in ensuring service quality and availability, access, and good management practice for the insured clients is crucial. Their role extends to translating the insurance policy into medical practice, an area which requires not only unique knowledge and skills but also experience [13]. In addition to their involvement in providing care, administratively healthcare personnel should work to create a conducive environment that responds to the health needs of the insured community and act as a link between patients and insurance schemes for billing and payment [14]. Literature addressing healthcare workers’ perceptions of the functioning of HI in SSA is scarce. In a study conducted in both Kenya and Ghana, health service providers reported how delayed reimbursement by insurance schemes negatively affected the ability of the facilities to restock medicines and pay bills [15]. In another study from Ghana, providers considered HI as a revenue source to finance facility activities, but complained about the failure of the scheme to provide reimbursement on time and ensure service availability, which influenced some providers to prioritise patients who could make cash payments [16]. Shortage of medicines and delayed Page 2 of 9 reimbursement have also been reported by service providers in the SSA context o (...truncated)