Summary of the Thesis

This thesis investigates the impact of health insurance on healthcare utilization and expenditures in Tanzania, focusing on gender disparities and health-seeking behavior. Using data from the Tanzania Demographic and Health Survey (TDHS) 2022, the study is structured into three empirical essays analyzing key challenges in Tanzania’s health insurance system and its implications for achieving Universal Health Coverage (UHC).

The first essay examines the progress and challenges of health insurance in Tanzania, highlighting that only 33% of Tanzanians are insured, primarily under the National Health Insurance Fund (NHIF) and the Improved Community Health Fund (iCHF). However, insurance penetration remains below 8% in rural and informal sectors, with affordability being a key barrier. The study finds that annual premiums of TZS 30,000–50,000 are beyond the reach of many low-income households.

The second essay explores gender disparities in insurance coverage. It reveals that only 20% of women in rural areas are insured compared to 35% of men. Insured women are 25% more likely to deliver in a health facility and 85% more likely to attend at least four antenatal visits compared to uninsured women. However, women in the informal sector face significant financial and structural barriers to obtaining health insurance due to irregular income and limited decision-making power over household healthcare choices.

The third essay assesses the impact of health insurance on health-seeking behavior and financial protection. Using Propensity Score Matching (PSM) and Oaxaca Decomposition, the study finds that insured individuals are 15% more likely to seek healthcare services than the uninsured. However, out-of-pocket (OOP) payments still account for 24.9% of total health expenditures, indicating that health insurance does not fully protect households from catastrophic medical costs, particularly for high-cost treatments such as cancer care and surgeries.

The study concludes that expanding health insurance coverage especially for women and informal sector workers is crucial for achieving UHC in Tanzania. Policy recommendations include: reducing premiums for low-income populations, integrating mobile money payment systems for flexible premium payments, and improving the quality of care to increase trust in public health insurance schemes.