Health insurance in rural Tanzania promotes self-care for among patients with non-communicable diseases via their disease management behaviours.

IF 2.3 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH International Health Pub Date : 2024-12-16 DOI:10.1093/inthealth/ihae070

Ayano Miyashita, Keiko Nakamura, Stephen M Kibusi, Eugene Benjamin Meshi, Anderson Bendera, Hideko Sato, Saber Al-Sobaihi, Yuri Tashiro, Kaushik L Ramaiya, Bruno F Sunguya, Kaoruko Seino

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Abstract

Background: The rise of hypertension (HTN) and diabetes mellitus (DM) in Tanzania underscores the importance of self-care practices (SCP) for disease management. Despite the proven effectiveness of SCP, financial barriers in resource-limited rural areas hinder continuous care. Health insurance (HI) emerges as a critical solution to alleviate financial constraints and support SCP.

Methods: This study examined an association between HI and SCP by generalised linear and ordinal logistic regressions, adjusted for sociodemographic factors. Mediation analysis highlighted the role of disease management behaviours (hospital visits and medication adherence) in the association. Data were collected through individual interviews with 909 patients.

Results: Better SCP for HTN and DM were associated with the National Health Insurance Fund (HTN: coefficient=0.571; DM: coefficient=0.567, p<0.001) and the improved Community Health Fund (iCHF) or CHF (HTN: coefficient=0.330; DM: coefficient=0.472, p<0.05), after adjustment for sociodemographic variables. Mediation analysis showed that disease management behaviours partially or fully mediated the relationship between HI and SCP.

Conclusions: Enrolment in HI by patients in rural Tanzania exhibited better disease management behaviours and SCP. Efforts should focus on leveraging the HI schemes to expand their coverage in rural areas, which could benefit patients with non-communicable diseases.

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坦桑尼亚农村地区的医疗保险通过非传染性疾病患者的疾病管理行为促进他们的自我保健。

背景：坦桑尼亚高血压（HTN）和糖尿病（DM）的上升强调了自我保健实践（SCP）对疾病管理的重要性。尽管SCP已被证明有效，但在资源有限的农村地区，资金障碍阻碍了持续的护理。健康保险（HI）成为缓解财政限制和支持SCP的关键解决方案。方法：本研究通过广义线性和有序逻辑回归检验了HI和SCP之间的关系，并对社会人口因素进行了调整。中介分析强调了疾病管理行为（医院就诊和药物依从性）在该关联中的作用。通过对909例患者的个别访谈收集数据。结果：HTN和DM的SCP较好与国民健康保险基金相关(HTN：系数=0.571；结论：坦桑尼亚农村参加HI的患者表现出较好的疾病管理行为和SCP。应侧重于利用医疗保险计划扩大其在农村地区的覆盖范围，这可能使非传染性疾病患者受益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： International Health is an official journal of the Royal Society of Tropical Medicine and Hygiene. It publishes original, peer-reviewed articles and reviews on all aspects of global health including the social and economic aspects of communicable and non-communicable diseases, health systems research, policy and implementation, and the evaluation of disease control programmes and healthcare delivery solutions. It aims to stimulate scientific and policy debate and provide a forum for analysis and opinion sharing for individuals and organisations engaged in all areas of global health.