Health-Related Quality of Life for the Insured and Non-Insured Elderly in Rural Tanzania: A Cross-Sectional Study

Abstract

Introduction: The growing number of elderlies in low—and middle-income countries is straining healthcare systems. Affordable health services are essential to prevent poor health outcomes and low quality of life. Health insurance can improve access to care and enhance the quality of life for elderly individuals. This study compares the quality of life of elderly individuals with and without health insurance.

Methods:  A household survey was conducted in the Nzega and Igunga districts in the Tabora region of Tanzania from 2017 to 2022. The survey used a multistage sampling method to select wards, villages in each district, and households with elderly residents. The European Quality of Life 5-dimension 3-level (EQ-5D-3L) instrument was used to assess health-related quality of life (HRQoL), including the EQ-5D descriptive system and the EQ visual analog scale (EQ VAS). Value sets from Zimbabwe were used to calculate HRQoL. The survey used crude and adjusted linear regression analyses to assess the relationship between HRQoL and HI by accounting for confounding factors.

Results: A total of 1,899 elderly individuals aged 60 years and above participated in the study, with the majority (58%) falling in the 60-69 age group. Among the participants, 45% were married, and only 44% had insurance coverage. The overall mean EQ-5D and EQ-VAS scores were slightly higher for the uninsured elderly (0.75 and 61.20) compared to the insured elderly (0.73 and 60.31). According to the linear crude model, there is a decrease in HRQoL among the uninsured compared to the insured. This trend was also observed in the adjusted model, although it was not statistically significant (p=0.052).

Conclusion: Access to health insurance can significantly improve the HRQoL for elderly populations in Tanzania. These findings are crucial for policymakers. Extending health insurance coverage to vulnerable sub-populations like the elderly should be a priority, with targeted financial subsidies for HI premiums. This initiative would be a significant step towards achieving universal health coverage in Tanzania, ensuring a higher quality of life for all citizens