Many LMICs have initiated reforms to their health care systems with a focus on improving the availability and accessibility of health care services for this vulnerable population group. Compounding this situation is the increasing need for health care services adapted to non-communicable diseases like diabetes, hypertension, a variety of cancers and deteriorating physical mobility, which predominantly affect the elderly. A large proportion of this group are socio-economically disadvantaged and live in rural areas with poor health care infrastructure. In low and middle-income countries (LMIC), health care systems are likely to be challenged by the rapidly increasing numbers of the elderly population. A continuous monitoring of health care system responsiveness is recommended.
Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. 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. Waiting time was the dimension that performed worst. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. ResultsĪ total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. MethodsĪ community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied.
This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population.
However, its measurement in sub-Saharan Africa remains scarce. Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients’ expectations.