Association between wealth status and health insurance enrollment among women aged 15-49 years in Tanzania: a secondary analysis of the 2022 Demographic and Health Survey.

Abstract

Background: A relationship between wealth status and health insurance enrollment among women in Tanzania is not well established. This study aimed to fill that gap by determining the association between wealth status and health insurance enrollment among women aged 15-49 years in Tanzania.

Methods: The study used secondary data from the 2022 Tanzania Demographic and Health Survey (TDHS). The binary dependent variable was health insurance enrollment. Independent variables included women's sociodemographic characteristics. Descriptive and inferential analyses were conducted. The level of association was measured using Adjusted Odds Ratio (AOR) at a 95% confidence interval (CI). A threshold of p < 0.05 was used to determine statistical significance.

Results: Overall, 5.8% (95% CI: 5.1%-6.6%) of women aged 15-49 years in Tanzania were enrolled in health insurance. Logistic regression results indicated that women who belonged to rich households (AOR=2.59; 95% CI: 1.91, 3.53), women aged 35-49 years (AOR=3.86; 95% CI: 2.90, 5.13), women with secondary or higher education (AOR=6.47; 95% CI: 4.17, 10.05), women residing in the Central zone (AOR=1.60; 95% CI: 1.12, 2.28), and women who visited a health facility in the past 12 months (AOR=1.37; 95% CI: 1.14, 1.63) had significantly higher odds of being enrolled. Women who perceived distance to a health facility as not a big problem (AOR=1.70; 95% CI: 1.27, 2.28) and women from female-headed households (AOR=1.29; 95% CI: 1.03, 1.62) also had higher odds of enrollment. Conversely, women who were divorced or separated (AOR=0.50; 95% CI: 0.35, 0.72), women residing in rural areas (AOR=0.68; 95% CI: 0.54, 0.86), and women in the Coastal zone (AOR=0.61; 95% CI: 0.44, 0.86) had significantly lower odds of enrollment.

Conclusion: Health insurance enrollment among women of reproductive age in Tanzania is low. There was a positive association between wealth status and health insurance enrollment. The government and other stakeholders should design targeted interventions, including linking households to social protection programs such as the Tanzania Social Action Fund (TASAF), to improve household wealth and thereby increase health insurance enrollment as the country works toward achieving universal health coverage.