Evidence map›Paper›PMID 34686182›Full record

ArticleBMC health services research2021

Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania.

Paul Joseph Amani, Anna-Karin Hurtig, Gasto Frumence, Angwara Denis Kiwara, Isabel Goicolea, Miguel San Sebastiån

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
6.4field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.

  1. Pooled it
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  5. Challenges and Opportunities of Universal Health Coverage in Africa: A Scoping Review.International journal of environmental research and public health · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 2 countries.

Paul Joseph AmaniDepartment of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania. paul.amani@umu.se.
Anna-Karin HurtigEpidemiology and Global Health, Umeå University, Umeå, Sweden.
Gasto FrumenceDepartment of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Angwara Denis KiwaraDepartment of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Isabel GoicoleaEpidemiology and Global Health, Umeå University, Umeå, Sweden.
Miguel San SebastiånEpidemiology and Global Health, Umeå University, Umeå, Sweden.
Umeå University · SEMuhimbili University of Health and Allied Sciences · TZMzumbe University · TZ

Funding

Styrelsen för Internationellt Utvecklingssamarbete SIDA under the Health System Research Subprogram 2015-2020
6 · The paper itself

Abstract

backgroundHealth insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania.

methodAn explanatory qualitative study was conducted in the rural districts of Igunga and Nzega, located in western-central Tanzania. Eight focus group discussions were carried out with 78 insured and uninsured elderly men and women who were purposely selected because they were 60 years of age or older and had utilised healthcare services in the past 12 months prior to the study. The interview questions were inspired by the domains of health systems' responsiveness. Qualitative content analysis was used to analyse the data.

resultsElderly participants appreciated that HI had facilitated the access to healthcare and protected them from certain costs. But they also complained that HI had failed to provide equitable access due to limited service benefits and restricted use of services within schemes. Although elderly perspectives varied widely across the domains of responsiveness, insured individuals generally expressed dissatisfaction with their healthcare.

conclusionsThe national health insurance policy should be revisited in order to improve its implementation and expand the scope of service coverage. Strategic decisions are required to improve the healthcare infrastructure, increase the number of healthcare workers, ensure the availability of medicines and testing facilities at healthcare centers, and reduce long administrative procedures related to HI. A continuous training plan for healthcare workers focused on patients´ communication skills and care rights is highly recommended.

Indexed as

Insurance, HealthMedically UninsuredAgedDelivery of Health CareFemaleGovernment ProgramsHumansInfantMaleTanzaniaelderlyhealthcare usehealth insuranceresponsivenessTanzania

Identifiers

PMID34686182
PMCPMC8532322
OpenAlexW3206476513

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.