Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior Researcher Ama Pokuaa Fenny, University of Ghana,
- Second opponent: Associate Professor Anni-Maria Pulkki-Brännström, Umeå University,
- Third member and chair of the evaluation committee: Associate professor Elia Mmbaga, University of Oslo
Chair of the Defence
Professor Kari Nyheim Solbrække, University of Oslo
Principal Supervisor
Professor Sverre Ole Grepperud, University of Oslo
Summary
This thesis aims to identify factors influencing rural households’ decision to enroll in a voluntary insurance scheme in Tanzania and assesses its impact on healthcare accessibility and catastrophic health expenditure (CHE). Cross-sectional study design was used and we applied quantitative approaches to collect and analyse the data collected from 722 respondents in two rural districts in Tanzania.
Paper I examine perception factors influencing households’ enrolment decisions to the voluntary insurance scheme. Paper II differentiates factors associated with enrollment or dropout and suggests relevant policy implications. Paper III studies risk preference's role among scheme members and non-members. Whereas, paper IV analyzes voluntary insurance (iCHF's) effects on healthcare utilization and catastrophic health expenditure (CHE) across socioeconomic status (SES).
The study found that household perception factors like perceived quality of care, household knowledge and scheme understanding, scheme convenience and household beliefs, affect enrollment decisions. Risk preference mainly determines enrollment status. Furthermore, the enrollment factors vary across the never-insured and dropout status. We found that never-insured and dropout status decisions were associated with high education level, absence of chronic disease, negative perceptions towards the quality of services, trust in scheme leaders and positive perceptions towards the traditional healers.
The results from paper IV suggest that insured households utilize healthcare more, with lower CHE incidence. Among the lowest socioeconomic groups, insured members utilize more healthcare and face lower CHE compared to non-members. The study recommends the enhancement of community understanding for informed decisions and identifying barriers to enrollment and healthcare utilization among the poorest households for policymaking towards Universal Health Coverage in Tanzania.
Additional information
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