Health Systems Responsiveness And Associated Client Patients Satisfaction Among Users And Non Users Of Health Insurance In Dodoma Region

ABSTRACT

Background In Tanzania the health insurance started as Community Health Fund (CHF) and was introduced as part of the Ministry of Health‘s (MoH) attempt to make health care affordable and available to the rural population and the informal sector. This scheme started in 1996 with Igunga as a pilot district and later expanded to other districts (Mtei & Mulligan, 2007). The objective of the study was to assess health systems responsiveness and associated clients/patients satisfaction among users and non-users of health insurance in the Dodoma region. Methods: Hospital-based analytical cross-sectional study that was conducted between June and July 2018 in different 08 health facilities at OPD in Dodoma. (N=406) client/patients were recruited by convenient sampling at OPD`s and interrogated by using an interview self-administered questionnaire. Data were analyzed through SPSS (V26.0) to develop descriptive statistics and logistic regression. Graphs and tables used to present the results of the analysis.

Results: The total number of respondents were (n= 406) from the 5 Districts of Dodoma Region purposively selected. Majority of respondents 137(33.7%) were from Dodoma referral Hospital, Bahi District Hospital 69(17.0%), Chemba 73(18.0%), Chamwino were 63(15.5%) and Kongwa 64(15.8%). This study reviles that the majority of 308 (75.9%) of respondents who visited hospitals had health insurance, while 98(24.1%) had no health insurance. Health systems responsiveness has shown 235(58%) perceived positive, 74(18%) perceived negative while 97(24%) were neutral. Among the seven domains of responsiveness, it is the only dignity that signifies the real influence of health insurance usage by 48% more (OR 0.48, PValue 0.002) with (AOR 0.563, P-Value 0.027). From focus level, the two categories of satisfaction with hospital hours by clients/patients and leaving hospital without extra charges have shown influence on the use of health insurance by (X 2 - 0.015, PValue 0.018) and (X 2 - 0.001, P-Value 0.002) respectively. When customer/patient are shown friendliness and courtesy (X2 - 0.002, P-Value 0.045), patients/customers adhered by medical personnel (X 2 - 0.020, P-Value 0.033) and enough hospital working hours with (X2 - 0.053 and P-Value 0.005). General the overall health insurance awareness with insurance stands at 82.35%, on the other side the awareness without insurance stand at 58.46%. Meanwhile, the general awareness for those who vi are not insured stands at 17.64% while for those without insurance and are not aware their figure stands at 41.54%.

Conclusion: This study has shown significant chances for some of the patterns of satisfaction, responsiveness, and awareness from clients/patients towards enrolling in various health insurance schemes. Health insurance agencies need to raise community awareness on health insurance for it has shown great positive significance. The responsiveness with health systems, the aspect of dignity out of seven domains is the only aspect with significance.