Exploring the Effects of Out-of-Pocket Payments on Healthcare Utilization in Rural and Urban Tanzania: A Gender Perspective

Abstract

Out-of-Pocket Payments (OPPs) have serious consequences for access to and utilization of health care and are particularly devastating for the poor. Although women constitute the majority of the poor in Tanzania and globally, the implications of user fees for access to health care from a gender perspective have received little attention. This study aimed to fill this gap by using a combination of quantitative and qualitative analyzes to investigate the gendered impact of OOPs on health care utilization in Kondoa District in both rural and urban areas. 206 households were interviewed and six single-sex focus groups were held. The study found that female-headed households (FHH) had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs. Direct payment was the main means of payment for health care for both households. Households in both rural and urban areas bear catastrophic burdens on health expenditure as it constitutes more than 10% of household income. Borrowing money was the main strategy applicable significantly in both rural and urban areas to cover health expenses. Out-of-pocket health expenditure had a significant relationship with untreated morbidity, medical visits, and coverage of treatment costs. There was also a significant inclusion of all household members, male and female, regarding health care decisions in all parameters assessed. It is therefore recommended to consider the introduction of affordable public health insurance schemes to ensure health insurance coverage for all individuals in both rural and urban areas. The vulnerability of women is also of particular concern and efforts to improve their access to health care should be encouraged. Health policies should also consider rural dwellers as a vulnerable group seeking affordable health services. On the other hand, the quality of public health expenditure must be improved by strengthening budget execution performance and better monitoring of public expenditure.