title: Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?
abstract: BACKGROUND
  Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members of the Community Health Fund, the National Health Insurance Fund and non-members in two districts in Tanzania.
  
  
  METHODS
  Using household survey data collected in 2011 with a sample of 3290 individuals, the study uses a multinomial logit model to examine the influence of predisposing, enabling and need characteristics on the probability of seeking care and choice of provider.
  
  
  RESULTS
  Generally, health insurance is found to increase the probability of seeking care and reduce delays. However, the probability, timing of seeking care and choice of provider varies across the CHF and NHIF members.
  
  
  CONCLUSIONS
  Reducing fragmentation is necessary to provide opportunities for redistribution and to promote equity in utilisation of health services. Improvement in the delivery of services is crucial for achievement of improved access and financial protection and for increased enrolment into the CHF, which is essential for broadening redistribution and cross-subsidisation to promote equity.
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania. e_chomi@yahoo.com.
authors.forename: Eunice Nahyuha
authors.initials: EN
authors.lastname: Chomi
authors.forename: Phares G M
authors.initials: PG
authors.lastname: Mujinja
authors.forename: Ulrika
authors.initials: U
authors.lastname: Enemark
authors.forename: Kristian
authors.initials: K
authors.lastname: Hansen
authors.forename: Angwara Dennis
authors.initials: AD
authors.lastname: Kiwara
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010342:Patient Acceptance of Health Care; D011203:Poverty; D013636:Tanzania; D019472:Universal Health Insurance; D055815:Young Adult