This paper aims to measure and decompose indicators of catastrophic health expenditure (CHE) among outpatients in Tanzania.
The dataset used in this cross-sectional study came from wave 4 of the Tanzanian National Panel Survey 2014–16 implemented by the National Bureau of Statistics of Tanzania. A total of 3,352 households were analysed. A threshold of 10% of total expenditure was used to establish how catastrophic the healthcare payments for outpatient care in Tanzania were.
At a 10% threshold, the out-of-pocket payments are catastrophic. 16.7% of households are exposed to CHE. In line with income groups, 35.2, 15.8, 16.6, 9.5 and 6.7% of households in the 1st, 2nd, 3rd, 4th and 5th quintiles, respectively, spent more than 10% of total expenditure on healthcare. Furthermore, the study found that households spent 25% of their total expenditure budget on healthcare. Additionally, concentration index values −0.318, −0.299 and −0.292 at thresholds 10, 15 and 25%, respectively, show that poor households suffer more than their counterparts in the highest quintiles. The design of the forthcoming universal health insurance scheme needs to consider households in the lowest quintile when setting premiums.
The study was confined to the United Republic of Tanzania; hence, its findings might not be extended to generalise households’ behaviour in another country. The nature of the questionnaire and the dataset available for our study did not provide room for us to extend the study and examine the contribution of transport costs and the possibility of incurring informal payments during hospital visits as well as the role of remittance and intrahousehold transfer in reducing CHE. A future study to capture data not present in the current design of the Tanzania NPS questionnaire is highly recommended.
The suggestion proposed in this research calls for re-engineering healthcare financing procedures in the country to cater to healthcare needs among the poor population by increasing public spending on health while considering the involvement of key stakeholders such as development partners and the private sector to achieve UHC progressively.
This study informs the status of catastrophic out-of-pocket costs for outpatient care. It serves as the baseline for assessing the implementation and performance of the forthcoming universal health insurance scheme in offsetting the challenge of out-of-pocket payments in Tanzania.
