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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Household perceptions towards a redistributive policy across health insurance funds in Tanzania

Authors: Eunice N Chomi, Phares GM Mujinja, Kristian Hansen, Angwara D Kiwara, Ulrika Enemark

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

The Tanzanian health insurance system comprises multiple health insurance funds targeting different population groups but which operate in parallel, with no mechanisms for redistribution across the funds. Establishing such redistributive mechanisms requires public support, which is grounded on the level of solidarity within the country. The aim of this paper is to analyse the perceptions of CHF, NHIF and non-member households towards cross-subsidisation of the poor as an indication of the level of solidarity and acceptance of redistributive mechanisms.

Methods

This study analyses data collected from a survey of 695 households relating to perceptions of household heads towards cross-subsidisation of the poor to enable them to access health services. Kruskal-Wallis test is used to compare perceptions by membership status. Generalized ordinal logistic regression models are used to identify factors associated with support for cross-subsidisation of the poor.

Results

Compared to CHF and NHIF households, non-member households expressed the highest support for subsidised CHF membership for the poor. The odds of expressing support for subsidised CHF membership are higher for NHIF households and non-member households, households that are wealthier, whose household heads have lower education levels, and have sick members. The majority of households support a partial rather than fully subsidised CHF membership for the poor and there were no significant differences by membership status. The odds of expressing willingness to contribute towards subsidised CHF membership are higher for households that are wealthier, with young household heads and have confidence in scheme management.

Conclusion

The majority may support a redistributive policy, but there are indications that this support and willingness to contribute to its achievement are influenced by the perceived benefits, amount of subsidy considered, and trust in scheme management. These present important issues for consideration when designing redistributive policies.
Literature
1.
Ministry of Health and Social Welfare. Tanzania National Health Accounts Year 2010 with Sub-Accounts for HIV and AIDS, Malaria, Reproductive, and Child Health. Dar es Salaam: Ministry of Health and Social Welfare; 2012.
2.
Ministry of Health and Social Welfare. Health Sector Public Expenditure Review, 2010/11. Dar es Salaam: Ministry of Health and Social Welfare and Health Systems 20/20 project Abt Associates Inc.; 2012.
3.
Musau S, Chee G, Patsika R, Malangalila E, Chitama D, Van Praag E, et al. Tanzania health system assessment 2010. Bethesda, MD: Health systems 20/20 project, Abt Associates Inc.; 2011.
4.
Haazen D. Making Health Financing Work for Poor People. Washington DC: World Bank; 2012.CrossRef
5.
National Health Insurance Fund. Actuarial valuation report of the National Health Insurance Fund. Dar-es-Salaam: M/S iPrint Ltd; 2010.
6.
Komter AE. The disguised rationality of solidarity: gift giving in informal relations. J Math Sociol. 2001;25:385–401.CrossRef
7.
Ulrich CG. Reciprocity, justice and statutory health insurance in Germany. J Eur Soc Policy. 2002;12(2):123–36.CrossRef
8.
Perneger TV, Hudelson PM. Public support for social financing of health care in Switzerland. Int J Health Serv. 2005;35(1):91–9.CrossRefPubMed
9.
Kakes J, de Winter J. Preferences for redistribution in the Netherlands, DNB Working Paper 2008, No. 179. Amsterdam: De Nederlandsche Bank; 2008.
10.
van Oorschot W, Meuleman B. Welfarism and the multidimensionality of welfare state legitimacy: evidence from the Netherlands. Int J Soc Welf. 2012;21(1):79–93.CrossRef
11.
Kikuzawa S, Olafdottir S, Pescosolido BA. Similar pressures, different contexts: public attitudes toward government intervention for health care in 21 nations. J Health Soc Behav. 2008;49:385–99.CrossRefPubMed
12.
Jæger MM. What makes people support public responsibility for welfare provision: self-interest of political ideology? A longitudinal approach. Acta Sociol. 2006;49:321–38.CrossRef
13.
James C, Savedoff W. Risk pooling and redistribution in health care: An empirical analysis of attitudes toward solidarity, World Health Report 2010. Background paper No. 5. Geneva: World Health Organisation; 2010.
14.
Heinemann F, Hennighausen T. "Don't tax me? Determinants of individual attitudes toward progressive taxation". ZEW Centre for European Economic Research 2010, Discussion Paper No. 10–017, ZEW Center for European Economic Research 2010, Discussion Paper No. 10–017. Munich: Centre for European Economic Research; 2010.
15.
Leon FJ. Reciprocity and public support for the redistributive role of the state. J Eur Soc Policy. 2012;22(2):198–215.CrossRef
16.
Wendt C, Kohl J, Mischke M, Pfeifer M. How do Europeans perceive their healthcare system? Patterns of satisfaction and preference for state involvement in the field of healthcare. Eur Socl Rev. 2010;26(2):177–92.CrossRef
17.
Linos K, West M. Self-interest, social beliefs, and attitudes to redistribution. Euro Sociol Rev. 2003;19:393–409.CrossRef
18.
Reed-Arthurs R, Sheffrin SM. Understanding the public’s attitudes towards redistribution through taxation, Tulane Economics Working Paper Series 2010, No. 1005. New Orleans: Tulane University; 2010.
19.
20.
Fong C, Bowles H, Gintis H. Handbook on the Economics of Giving, Altruism and Reciprocity. Volume 2. In: Kolm S-C, Ythier JM, editors. Strong reciprocity and the welfare state. Amsterdam: Elservier; 2006. p. 1439–64.
21.
Dohmen T, Falk A, Huffman D, Sunde U. Homo reciprocans: Survey evidence on behavioural outcomes. Econ J. 2009;119:592–612.CrossRef
22.
Monroe KR. A fat lady in a corset: altruism and social theory. Am J Polit Sci. 1994;38(4):861–93.CrossRef
23.
Batson DC, Shaw LL. Evidence for Altruism: Towards a Pluralism of Prosocial Motives. Psychol Inq. 1991;2(2):107–22.CrossRef
24.
Batson DC, Moran T. Empathy-induced Altruism in a Prisoner's Dilemma. Eur J Soc Psychol. 1999;29:909–24.CrossRef
25.
Fehr E, Schmidt KM. Theories of fairness and reciprocity- evidence and economic applications. In: Kolm S-C, Ythier JM, editors. Handbook on the Economics of Giving, Altruism and Reciprocity. Volume I. Amsterdam: Elsevier; 2006. p. 615–91.
26.
Armitage CJ, Conners M. Social Cognitive Determinants of Blood Donation. J Appl Soc Psychol. 2001;31(7):1431–57.CrossRef
27.
Piliavin JA, Charng HW. Altruism: a review of recent of theory and research. Annu Rev Social. 1990;16:27–65.CrossRef
28.
Kolm SC. Reciprocity: An economics of social relations. New York: Cambridge University Press; 2008.CrossRef
29.
Gintis H, Henrich J, Bowles S, Boyd R, Fehr E. Strong reciprocity and the roots of human morality. Soc Just Res. 2008;21(2):241–53.CrossRef
30.
Arhinful DK. The solidarity of self-interest: Social and cultural feasibility of rural health insurance in Ghana. African Studies Centre: Leiden University; 2003.
31.
Ministry of Health and Social Welfare. Tanzania. Annual Health Statistical Abstract. Ministry of Health and Social Welfare: Dar-es-Salaam; 2011.
32.
Vidgerhous G. The level of measurement and “permissible” statistical analysis in social research. Pac Soc Rev. 1977;20(1):61–72.CrossRef
33.
Babbie ER. The practice of social research. 12th ed. Belmont: Wadsworth; 2010.
34.
35.
Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Oxford: Oxford University Press; 2006.
36.
Filmer D, Pritchett L. Estimating wealth effects without expenditure data – or tears. An application to educational enrolment states in India, World Bank Policy Research Working Paper 1998. Washington DC: World Bank; 1998.
37.
Jackobsson U. Statistical presentation and analysis of ordinal data in nursing research. Scand J Caring Sci. 2004;18:437–40.CrossRef
38.
Long JS, Freese J. Regression Models for Categorical Dependent variable Using Stata. Texas: Stata Press; 2006.
39.
Alesina A, La Ferrara E. Preferences for redistribution in the land of opportunities. J Public Econ. 2005;89:897–931.CrossRef
40.
Neher F. Preferences for redistribution across the world. School of Business & Economics Discussion Paper: Economics. No. 2012/2. Berlin: Freie Univ. Berlin, FB Wirtschaftswiss; 2012.
41.
Goudge J, Akazili J, Ataguba J, Kuwawenaruwa A, Borghi J, Harris B, et al. Social solidarity and willingness to accept risk- and income-related cross-subsidies within health insurance: experiences from Ghana, Tanzania and South Africa. Health Policy Plann. 2012;27:i55–63.CrossRef
42.
Harris B, Nxumalo N, Ataguba JE, Govender V, Chersich M, Goudge J. Social solidarity and civil servants’ willingness for financial cross-subsidization in South Africa: Implications for health financing reform. J Public Health Policy. 2011;32 Suppl 1:S162–83.CrossRefPubMed
43.
Smith A. The Theory of Moral Sentiments. Oxford: Oxford University Press; 1853.
44.
Government of Rwanda. Rwanda Health financing Policy. Kigali: Ministry of Health; 2010.
45.
Dalinjong PA, Laar AS. The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana. Health Econ Rev. 2012;2(13):1–13.
46.
United Republic of Tanzania. Household Budget Survey 2007 – Mainland Tanzania. Dar es Salaam: National Bureau of Statistics; 2009.
47.
Becker GS. A Theory of Social Interactions. J Polit Econ. 1974;82(6):1063–93.CrossRef
48.
Schneider P. Trust in micro-health insurance: an exploratory study in Rwanda. Soc Sci Med. 2005;61:1430–8.CrossRefPubMed
Metadata
Title
Household perceptions towards a redistributive policy across health insurance funds in Tanzania
Authors
Eunice N Chomi
Phares GM Mujinja
Kristian Hansen
Angwara D Kiwara
Ulrika Enemark
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0761-z

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