The relationship between practical lifestyles and cost escalation over members’ contribution to health insurance in Tanzania: The mediation of non-communicable diseases

Authors

DOI:

https://doi.org/10.20525/ijrbs.v14i3.4051

Keywords:

Lifestyles, Cost Escalation, Members’ Contribution, Health Insurance, Non-Communicable Diseases

Abstract

This study aimed to examine the correlation between health-risk behaviour patterns, health lifestyle practices, and self-monitoring and care, in connection to the increasing costs of health insurance premiums. The research utilised a cross-sectional design and applied Linear Regression via SPSS software to analyse data collected from 385 public servants and college students in Mwanza, constituting 68.84% of the NHIF membership share. The analysis reveals that hazardous behaviours, including Alcohol Consumption (AC), Tobacco Use (TU), and Exposure to Harmful Chemicals (ETHC), are directly correlated with an increase in insurance costs. Nonetheless, the use of painkillers is unwarrantedly associated with the development of non-communicable diseases. Healthy lifestyle practices, including the consumption of processed foods (PFC), adherence to a balanced diet (UBD), and participation in physical activity (PA), are positively correlated with the likelihood of acquiring non-communicable diseases (NCD). In the near term, patients undergoing regular medical checks (MCP) exhibited elevated medical expenses. Ultimately, they decreased long-term medical costs by mitigating the likelihood of an individual developing non-communicable diseases (NCDs). The study emphasises policy recommendations aimed at reducing the likelihood of non-communicable disease (NCD) development and enhancing the financial stability of health insurance schemes in Tanzania. These include the creation of media and electronic campaigns to inform both members and non-members about effective strategies to prevent NCDs, the establishment of incentive packages to encourage members to cease or abandon risky behaviours, the provision of discounted premium pricing, the offering of mental health counselling and therapy programs, and the development or acquisition of health-related applications to modify member behaviour.

Downloads

Download data is not yet available.

References

Adeyi, O., Smith, O., & Robles, S. (2007). Public policy and the challenge of chronic non-communicable diseases. World Bank Publications. DOI: https://doi.org/10.1596/978-0-8213-7044-5

Ahmed, H., & Cowan, B. (2021). Mobile money and healthcare use: Evidence from East Africa. World Development, 141, 105392. https://doi.org/10.1016/j.worlddev.2021.105392 DOI: https://doi.org/10.1016/j.worlddev.2021.105392

Ahmed, M. M., Ibrahim, R. M., & Younis, N. M. (2024). Perceived susceptibility toward smoking among students. Journal of Current Medical Research and Opinion, 7(07), 3217–3225. https://doi.org/10.52845/CMRO/2024/7-7-16

Alamnia, T. T., Sargent, G. M., & Kelly, M. (2023). Dietary patterns and associations with metabolic risk factors for non-communicable disease. Scientific Reports, 13(1), 21028. https://doi.org/10.1038/s41598-023-47548-0 DOI: https://doi.org/10.1038/s41598-023-47548-0

Alhasawi, A., Grover, S. B., Sadek, A., Ashoor, I., Alkhabbaz, I., & Almasri, S. (2019). Assessing HIV/AIDS knowledge, awareness, and attitudes among senior high school students in Kuwait. Medical Principles and Practice, 28(5), 470–476. https://doi.org/10.1159/000500307 DOI: https://doi.org/10.1159/000500307

Allen, L. N., Nicholson, B. D., Yeung, B. Y., & Goiana-da-Silva, F. (2020). Implementation of non-communicable disease policies: A geopolitical analysis of 151 countries. The Lancet Global Health, 8(1), e50–e58. https://doi.org/10.1016/S2214-109X(19)30446-2 DOI: https://doi.org/10.1016/S2214-109X(19)30446-2

Banatvala, N., & Bovet, P. (2023). Noncommunicable Diseases: A Compendium (p. 489). Taylor & Francis. https://library.oapen.org/handle/20.500.12657/60704 DOI: https://doi.org/10.4324/9781003306689

Barr, D. A. (2023). Introduction to US health policy: The organization, financing, and delivery of health care in America. JHU Press.

Bertram, M. Y., Sweeny, K., Lauer, J. A., Chisholm, D., Sheehan, P., Rasmussen, B., ... & Deane, S. (2018). Investing in non-communicable diseases: An estimation of the return on investment for prevention and treatment services. The Lancet, 391(10134), 2071–2078. DOI: https://doi.org/10.1016/S0140-6736(18)30665-2

Bolarinwa, O. A., Ameh, S., Ochimana, C., Oluwasanu, A. O., Samson, O., Mohamed, S. F., ... & Danaei, G. (2021). Willingness and ability to pay for healthcare insurance: A cross-sectional study of Seven Communities in East and West Africa (SevenCEWA). PLOS Global Public Health, 1(11), e0000057. https://doi.org/10.1371/journal.pgph.0000057 DOI: https://doi.org/10.1371/journal.pgph.0000057

Briggs, A. M., Persaud, J. G., Deverell, M. L., Bunzli, S., Tampin, B., Sumi, Y., ... & Slater, H. (2019). Integrated prevention and management of non-communicable diseases, including musculoskeletal health: A systematic policy analysis among OECD countries. BMJ Global Health, 4(5), e001806. DOI: https://doi.org/10.1136/bmjgh-2019-001806

Bryant, J. (2019). Health and the developing world. Cornell University Press. DOI: https://doi.org/10.7591/9781501741456

Bundorf, M. K., Gupta, S., & Kim, C. (2021, September). Trends in US health insurance coverage during the COVID-19 pandemic. JAMA Health Forum, 2(9), e212487. https://doi.org/10.1001/jamahealthforum.2021.2487 DOI: https://doi.org/10.1001/jamahealthforum.2021.2487

Calista, N., Haikael, M. D., Athanasia, M. O., Neema, K., & Judith, K. (2022). Does pesticide exposure contribute to the growing burden of non-communicable diseases in Tanzania? Scientific African, 17, e01276. https://doi.org/10.1016/j.sciaf.2022.e01276 DOI: https://doi.org/10.1016/j.sciaf.2022.e01276

Campbell, D. (2024). UK’s unhealthy food habits cost £268bn a year, report finds. The Guardian. https://www.theguardian.com/politics/2024/nov/15/uk-unhealthy-food-costs-268bn-a-year-report-food-farming-countryside-nhs

Campenni, M., Cronk, L., & Aktipis, A. (2017). Correlated disasters and need-based transfers: The limits of risk pooling systems in simulated ecologies. BioRxiv, 230607. DOI: https://doi.org/10.1101/230607

Cena, H., & Calder, P. C. (2020). Defining a healthy diet: Evidence for the role of contemporary dietary patterns in health and disease. Nutrients, 12(2), 334. https://doi.org/10.3390/nu12020334 DOI: https://doi.org/10.3390/nu12020334

Cerf, M. E. (2021). Healthy lifestyles and noncommunicable diseases: Nutrition, the life?course, and health promotion. Lifestyle Medicine, 2(2), e31. https://doi.org/10.1002/lim2.31 DOI: https://doi.org/10.1002/lim2.31

Chaturvedi, P., Singh, A., Chien, C. Y., & Warnakulasuriya, S. (2019). Tobacco-related oral cancer. BMJ, 365, l2142. https://doi.org/10.1136/bmj.l2142 DOI: https://doi.org/10.1136/bmj.l2142

Chen, Z. X., Hohmann, L., Banjara, B., Zhao, Y., Diggs, K., & Westrick, S. C. (2020). Recommendations to protect patients and health care practices from Medicare and Medicaid fraud. Journal of the American Pharmacists Association, 60(6), e60–e65. https://doi.org/10.1016/j.japh.2020.05.011 DOI: https://doi.org/10.1016/j.japh.2020.05.011

Chen, X., Zhang, Z., Yang, H., Qiu, P., Wang, H., Wang, F., ... & Nie, J. (2020). Consumption of ultra-processed foods and health outcomes: A systematic review of epidemiological studies. Nutrition Journal, 19, 86. https://doi.org/10.1186/s12937-020-00604-1 DOI: https://doi.org/10.1186/s12937-020-00604-1

Countdown, N. C. D. (2022). NCD Countdown 2030: Efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries. The Lancet, 399(10331), 1266. https://doi.org/10.1016/S0140-6736(21)02347-3 DOI: https://doi.org/10.1016/S0140-6736(21)02347-3

Cowling, N. (2024). Number of students enrolled in universities and colleges in Tanzania from 2017/18 to 2019/20, by institution type. Statista. https://www.statista.com/statistics/1260497/number-of-students-in-universities-in-tanzania/

Cuadrado, C., Crispi, F., Libuy, M., Marchidon, G., & Cid, C. (2019). National health insurance: A conceptual framework from conflicting typologies. Health Policy, 123(7), 621–629. https://doi.org/10.1016/j.healthpol.2019.05.013 DOI: https://doi.org/10.1016/j.healthpol.2019.05.013

Cychosz, M. C. (1994). Structural equation modeling of Health Belief Model influences on exercise behavior among medical center employees.

Daramola, O. E., Abu, J. M., Daramola, L. O., & Akande, T. M. (2019). Medical identity fraud in health insurance schemes: Creating awareness in Nigeria. Asian Journal of Case Reports in Medicine and Health, 2(1), 37–42.

Davila, E. P., Suleiman, Z., Mghamba, J., Rolle, I., Ahluwalia, I., Mmbuji, P., ... & Jarrar, B. (2015). Non-communicable disease training for public health workers in low and middle-income countries: Lessons learned from a pilot training in Tanzania. International Health, 7(5), 339–347. https://doi.org/10.1093/inthealth/ihu090 DOI: https://doi.org/10.1093/inthealth/ihu090

Davis, L. L., Schein, J., Cloutier, M., Gagnon-Sanschagrin, P., Maitland, J., Urganus, A., ... & Houle, C. R. (2022). The economic burden of posttraumatic stress disorder in the United States from a societal perspective. The Journal of Clinical Psychiatry, 83(3), 40672. https://doi.org/10.4088/JCP.21m14116 DOI: https://doi.org/10.4088/JCP.21m14116

de Araújo, T. P., de Moraes, M. M., Magalhães, V., Afonso, C., Santos, C., & Rodrigues, S. S. (2021). Ultra-processed food availability and noncommunicable diseases: A systematic review. International Journal of Environmental Research and Public Health, 18(14), 7382. https://doi.org/10.3390/ijerph18147382 DOI: https://doi.org/10.3390/ijerph18147382

de Miranda, R. C., Rauber, F., de Moraes, M. M., Afonso, C., Santos, C., Rodrigues, S., & Levy, R. B. (2021). Consumption of ultra-processed foods and non-communicable disease-related nutrient profile in Portuguese adults and elderly (2015–2016): The UPPER project. British Journal of Nutrition, 125(10), 1177–1187. https://doi.org/10.1017/S000711452000344X DOI: https://doi.org/10.1017/S000711452000344X

D'Onofrio, G., Kirschner, J., Prather, H., Goldman, D., & Rozanski, A. (2023). Musculoskeletal exercise: Its role in promoting health and longevity. Progress in Cardiovascular Diseases, 77, 25–36. https://doi.org/10.1016/j.pcad.2023.02.006 DOI: https://doi.org/10.1016/j.pcad.2023.02.006

Dubey, S., Deshpande, S., Krishna, L., & Zadey, S. (2023). Evolution of government-funded health insurance for universal health coverage in India. The Lancet Regional Health – Southeast Asia, 13. https://doi.org/10.1016/j.lansea.2023.100180 DOI: https://doi.org/10.1016/j.lansea.2023.100180

Eberly, L. A., Rusangwa, C., Neal, C. C., Mukundiyukuri, J. P., Mpanusingo, E., Mungunga, J. C., ... & Bukhman, G. (2019). Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda. BMJ Global Health, 4(3), e001449. DOI: https://doi.org/10.1136/bmjgh-2019-001449

Etemadi, A., Safiri, S., Sepanlou, S. G., Ikuta, K., Bisignano, C., Shakeri, R., ... & Sekerija, M. (2020). The global, regional, and national burden of stomach cancer in 195 countries, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology, 5(1), 42–54. https://doi.org/10.1016/S2468-1253(19)30328-0 DOI: https://doi.org/10.1016/S2468-1253(19)30328-0

Fabricant, P. D., McLaren, S. H., Suryavanshi, J. R., Nwachukwu, B. U., & Dodwell, E. R. (2019). Association between government health insurance status and physical activity in American youth. Journal of Pediatric Orthopaedics, 39(7), e552–e557. https://doi.org/10.1097/BPO.0000000000001329 DOI: https://doi.org/10.1097/BPO.0000000000001329

Fitzgerald, C., Burley, D. C., Wright, D. K., McLeod, D. K., & Parmenter, A. P. B. (2024). Improving mental health, pain and quality of life in persons living with osteoporosis and depression or anxiety: A systematic review. Journal of Clinical Exercise Physiology, 13(s2), 516. https://doi.org/10.31189/2165-7629-13-s2.516 DOI: https://doi.org/10.31189/2165-7629-13-s2.516

Frumkin, H., & Haines, A. (2019). Global environmental change and noncommunicable disease risks. Annual Review of Public Health, 40, 261–282. https://doi.org/10.1146/annurev-publhealth-040218-043706 DOI: https://doi.org/10.1146/annurev-publhealth-040218-043706

Garg, S., Bebarta, K. K., & Tripathi, N. (2022). Role of publicly funded health insurance in financial protection of the elderly from hospitalization expenditure in India: Findings from the Longitudinal Aging Study. BMC Geriatrics, 22(1), 572. https://doi.org/10.1186/s12877-022-03266-2 DOI: https://doi.org/10.1186/s12877-022-03266-2

Geidl, W., Abu-Omar, K., Weege, M., Messing, S., & Pfeifer, K. (2020). German recommendations for physical activity and physical activity promotion in adults with noncommunicable diseases. International Journal of Behavioral Nutrition and Physical Activity, 17, 17. https://doi.org/10.1186/s12966-020-0919-x DOI: https://doi.org/10.1186/s12966-020-0919-x

Geldsetzer, P. (2020). Use of rapid online surveys to assess people's perceptions during infectious disease outbreaks: A cross-sectional survey on COVID-19. Journal of Medical Internet Research, 22(4), e18790. https://doi.org/10.2196/18790 DOI: https://doi.org/10.2196/18790

GHR, G., & Aithal, P. S. (2022). When to collect data? Choosing an appropriate time frame for data collection during PhD program in India? International Journal of Applied Engineering and Management Letters, 6(2), 271–287. https://doi.org/10.5281/zenodo.7296552 DOI: https://doi.org/10.47992/IJAEML.2581.7000.0158

Goff, L. M. (2019). Ethnicity and type 2 diabetes in the UK. Diabetic Medicine, 36(8), 927–938. https://doi.org/10.1111/dme.13895 DOI: https://doi.org/10.1111/dme.13895

Gooch, K., Culleton, B. F., Manns, B. J., Zhang, J., Alfonso, H., Tonelli, M., ... & Hemmelgarn, B. R. (2007). NSAID use and progression of chronic kidney disease. The American Journal of Medicine, 120(3), 280.e1–280.e7. https://doi.org/10.1016/j.amjmed.2006.02.015 DOI: https://doi.org/10.1016/j.amjmed.2006.02.015

Green, C. E., Murphy, M. E., & Gryboski, K. (2020). The Health Belief Model. In S. B. Nezu & C. M. Nezu (Eds.), The Wiley Encyclopedia of Health Psychology. https://doi.org/10.1002/9781119057840.ch68 DOI: https://doi.org/10.1002/9781119057840.ch68

Greenfield, B. (2020). Boundless: Upgrade your brain, optimize your body & defy aging. Victory Belt Publishing.

Hamidi, H. (2019). An approach to developing smart health using the Internet of Things and authentication based on biometric technology. Future Generation Computer Systems, 91, 434–449. https://doi.org/10.1016/j.future.2018.09.024 DOI: https://doi.org/10.1016/j.future.2018.09.024

Haque, M., Islam, T., Rahman, N. A. A., McKimm, J., Abdullah, A., & Dhingra, S. (2020). Strengthening primary healthcare services to help prevent and control long-term (chronic) non-communicable diseases in low-and middle-income countries. Risk Management and Healthcare Policy, 13, 409–426. https://doi.org/10.2147/RMHP.S239074 DOI: https://doi.org/10.2147/RMHP.S239074

Herrick, C. (2020). The optics of noncommunicable diseases: From lifestyle to environmental toxicity. Sociology of Health & Illness, 42(5), 1041–1059. https://doi.org/10.1111/1467-9566.13078 DOI: https://doi.org/10.1111/1467-9566.13078

Hosseinkhani, F., Heinken, A., Thiele, I., Lindenburg, P. W., Harms, A. C., & Hankemeier, T. (2021). The contribution of gut bacterial metabolites in the human immune signaling pathway of non-communicable diseases. Gut Microbes, 13(1), 1882927. https://doi.org/10.1080/19490976.2021.1882927 DOI: https://doi.org/10.1080/19490976.2021.1882927

Juul, F., Vaidean, G., & Parekh, N. (2021). Ultra-processed foods and cardiovascular diseases: Potential mechanisms of action. Advances in Nutrition, 12(5), 1673–1680. https://doi.org/10.1093/advances/nmab049 DOI: https://doi.org/10.1093/advances/nmab049

Kitole, F. A., Lihawa, R. M., & Mkuna, E. (2024). Comparative analysis on communicable and non-communicable diseases on catastrophic spending and impoverishment in Tanzania. Global Social Welfare, 11(2), 123–134. https://doi.org/10.1007/s40609-022-00241-y DOI: https://doi.org/10.1007/s40609-022-00241-y

Kazibwe, J., Tran, P. B., & Annerstedt, K. S. (2021). The household financial burden of non-communicable diseases in low- and middle-income countries: A systematic review. Health Research Policy and Systems, 19, 96. https://doi.org/10.1186/s12961-021-00732-y DOI: https://doi.org/10.1186/s12961-021-00732-y

Keisler-Starkey, K., & Bunch, L. N. (2020). Health insurance coverage in the United States: 2019. US Census Bureau.

Kerkez, M., Aktürk, Ü., & Erci, B. (2023). Examining the relationship between schoolchildren's physical activity and nutrition status. Ordu Üniversitesi Hem?irelik Çal??malar? Dergisi, 7(3), 624–633. https://doi.org/10.38108/ouhcd.1363914 DOI: https://doi.org/10.38108/ouhcd.1363914

Khamis, A. G., Mwanri, A. W., Senkoro, M., Kreppel, K., Bonfoh, B., Mfinanga, S. G., & Kwesigabo, G. (2022). Dietary patterns, nutrient intakes and metabolic conditions among agro-pastoralists in Monduli District, Tanzania. Nutrition and Dietary Supplements, 11–20. https://doi.org/10.2147/NDS.S355730 DOI: https://doi.org/10.2147/NDS.S355730

Kivimäki, M., & Steptoe, A. (2018). Effects of stress on the development and progression of cardiovascular disease. Nature Reviews Cardiology, 15(4), 215–229. DOI: https://doi.org/10.1038/nrcardio.2017.189

Khan, H. T. (2019). Population aging in a globalized world: Risks and dilemmas? Journal of Evaluation in Clinical Practice, 25(5), 754–760. https://doi.org/10.1111/jep.13071 DOI: https://doi.org/10.1111/jep.13071

Koike, M. K., & Cardoso, R. (2014). Meditation can produce beneficial effects to prevent cardiovascular disease. Hormone Molecular Biology and Clinical Investigation, 18(3), 137–143. https://doi.org/10.1515/hmbci-2013-0056 DOI: https://doi.org/10.1515/hmbci-2013-0056

Krishnaveni, G. V., & Srinivasan, K. (2019). Maternal nutrition and offspring stress response—Implications for future development of non-communicable disease: A perspective from India. Frontiers in Psychiatry, 10, 795. https://doi.org/10.3389/fpsyt.2019.00795 DOI: https://doi.org/10.3389/fpsyt.2019.00795

Kumar, M., Sarma, D. K., Shubham, S., Kumawat, M., Verma, V., Prakash, A., & Tiwari, R. (2020). Environmental endocrine-disrupting chemical exposure: Role in non-communicable diseases. Frontiers in Public Health, 8, 553850. https://doi.org/10.3389/fpubh.2020.553850 DOI: https://doi.org/10.3389/fpubh.2020.553850

Li, J. B., Yang, A., Dou, K., Wang, L. X., Zhang, M. C., & Lin, X. Q. (2020). Chinese public’s knowledge, perceived severity, and perceived controllability of COVID-19 and their associations with emotional and behavioral reactions, social participation, and precautionary behavior: A national survey. BMC Public Health, 20, 1413. https://doi.org/10.1186/s12889-020-09695-1 DOI: https://doi.org/10.1186/s12889-020-09695-1

Li, Y., Fan, X., Wei, L., Yang, K., & Jiao, M. (2023). The impact of high-risk lifestyle factors on all-cause mortality in the US non-communicable disease population. BMC Public Health, 23(1), 422. https://doi.org/10.1186/s12889-023-15319-1 DOI: https://doi.org/10.1186/s12889-023-15319-1

Liu, X., Cao, H., Zhu, H., Zhang, H., Niu, K., Tang, N., ... & Zhang, L. (2021). Association of chronic diseases with depression, anxiety and stress in Chinese general population: The CHCN-BTH cohort study. Journal of Affective Disorders, 282, 1278–1287. https://doi.org/10.1016/j.jad.2021.01.040 DOI: https://doi.org/10.1016/j.jad.2021.01.040

Liu, J., Lee, Y., Micha, R., Li, Y., & Mozaffarian, D. (2021). Trends in junk food consumption among US children and adults, 2001–2018. The American Journal of Clinical Nutrition, 114(3), 1039–1048. https://doi.org/10.1093/ajcn/nqab129 DOI: https://doi.org/10.1093/ajcn/nqab129

Ma?kiewicz, M. A., Szarmach, A., Sabisz, A., Cuba?a, W. J., Szurowska, E., & Winklewski, P. J. (2019). Blood-brain barrier permeability and physical exercise. Journal of Neuroinflammation, 16, 47. https://doi.org/10.1186/s12974-019-1403-x DOI: https://doi.org/10.1186/s12974-019-1403-x

Marrón-Ponce, J. A., Flores, M., Cediel, G., Monteiro, C. A., & Batis, C. (2019). Associations between consumption of ultra-processed foods and intake of nutrients related to chronic non-communicable diseases in Mexico. Journal of the Academy of Nutrition and Dietetics, 119(11), 1852–1865. https://doi.org/10.1016/j.jand.2019.04.020 DOI: https://doi.org/10.1016/j.jand.2019.04.020

Mathauer, I., Torres, L. V., Kutzin, J., Jakab, M., & Hanson, K. (2019). Pooling financial resources for universal health coverage: Options for reform. Bulletin of the World Health Organization, 98(2), 132–139. https://doi.org/10.2471/BLT.19.234153 DOI: https://doi.org/10.2471/BLT.19.234153

Matos, R. A., Adams, M., & Sabaté, J. (2021). The consumption of ultra-processed foods and non-communicable diseases in Latin America. Frontiers in Nutrition, 8, 622714. https://doi.org/10.3389/fnut.2021.622714 DOI: https://doi.org/10.3389/fnut.2021.622714

Menhas, R., Dai, J., Ashraf, M. A., Noman, S. M., Khurshid, S., Mahmood, S., ... & Iqbal, W. (2021). Physical inactivity, non-communicable diseases and national fitness plan of China for physical activity. Risk Management and Healthcare Policy, 14, 2319–2331. https://doi.org/10.2147/RMHP.S258660 DOI: https://doi.org/10.2147/RMHP.S258660

Moreno-Agostino, D., Daskalopoulou, C., Wu, Y. T., Koukounari, A., Haro, J. M., Tyrovolas, S., ... & Prina, A. M. (2020). The impact of physical activity on healthy ageing trajectories: Evidence from eight cohort studies. International Journal of Behavioral Nutrition and Physical Activity, 17, 104. https://doi.org/10.1186/s12966-020-00995-8 DOI: https://doi.org/10.1186/s12966-020-00995-8

Murphy, A., Palafox, B., Walli-Attaei, M., Powell-Jackson, T., Rangarajan, S., Alhabib, K. F., ... & McKee, M. (2020). The household economic burden of non-communicable diseases in 18 countries. BMJ Global Health, 5(2), e002040. DOI: https://doi.org/10.1136/bmjgh-2019-002040

Mushi, L., Krohn, M., & Flessa, S. (2015). Cost of dialysis in Tanzania: Evidence from the provider’s perspective. Health Economics Review, 5, 1–10. https://doi.org/10.1186/s13561-015-0064-4 DOI: https://doi.org/10.1186/s13561-015-0064-4

Nadkarni, A., Bhatia, U., Shaik, I., Roy, M., Kaliyaperumal, A., Awasthi, A., & Madan, V. (2024). Comorbidity of alcohol use disorders and non-communicable diseases in low- and middle-income countries. Journal of Substance Use, 29(5), 905–913. https://doi.org/10.1080/14659891.2023.2202745 DOI: https://doi.org/10.1080/14659891.2023.2202745

Nazarov, S., Manuwald, U., Leonardi, M., Silvaggi, F., Foucaud, J., Lamore, K., ... & Rothe, U. (2019). Chronic diseases and employment: Which interventions support the maintenance of work and return to work among workers with chronic illnesses? A systematic review. International Journal of Environmental Research and Public Health, 16(10), 1864. https://doi.org/10.3390/ijerph16101864 DOI: https://doi.org/10.3390/ijerph16101864

Ndumwa, H. P., Mori, A. T., Ruhago, G. M., Willilo, R., McBain, R., Boudreaux, C., ... & Kaarboe, O. (2024). Cost analysis for initiating an integrated package of essential non-communicable disease interventions (PEN-Plus) in Kondoa District Hospital, Tanzania: A time-driven activity-based costing (TDABC) study protocol. BMJ Open, 14(5), e080510. https://doi.org/10.1136/bmjopen-2023-080510 DOI: https://doi.org/10.1136/bmjopen-2023-080510

Ng, J. Y., Santoro, L. J., Cobey, K. D., Steel, A., Cramer, H., & Moher, D. (2024). Complementary, alternative, and integrative medicine researchers’ practices and perceived barriers related to open science: An international, cross-sectional survey. PLOS ONE, 19(5), e0301251. https://doi.org/10.1371/journal.pone.0301251 DOI: https://doi.org/10.1371/journal.pone.0301251

Nilson, E. A. F., Ferrari, G., Louzada, M. L. D. C., Levy, R. B., Monteiro, C. A., & Rezende, L. F. (2022). The estimated burden of ultra-processed foods on cardiovascular disease outcomes in Brazil: A modeling study. Frontiers in Nutrition, 9, 1043620. https://doi.org/10.3389/fnut.2022.1043620 DOI: https://doi.org/10.3389/fnut.2022.1043620

Nordgren, L., von Heideken Wågert, P., Söderlund, A., & Elvén, M. (2022). The mediating role of healthy lifestyle behaviours on the association between perceived stress and self-rated health in people with non-communicable disease. International Journal of Environmental Research and Public Health, 19(19), 12071. https://doi.org/10.3390/ijerph191912071 DOI: https://doi.org/10.3390/ijerph191912071

Nshakira-Rukundo, E., Mussa, E. C., Nshakira, N., Gerber, N., & von Braun, J. (2019). Determinants of enrolment and renewing of community-based health insurance in households with under-5 children in rural south-western Uganda. International Journal of Health Policy and Management, 8(10), 593. https://doi.org/10.15171/ijhpm.2019.49 DOI: https://doi.org/10.15171/ijhpm.2019.49

Novignon, J., Lanko, C., & Arthur, E. (2021). Political economy and the pursuit of universal health coverage in Ghana: A case study of the National Health Insurance Scheme. Health Policy and Planning, 36(Supplement_1), i14–i21. https://doi.org/10.1093/heapol/czab061 DOI: https://doi.org/10.1093/heapol/czab061

Nugent, R., Bertram, M. Y., Jan, S., Niessen, L. W., Sassi, F., Jamison, D. T., ... & Beaglehole, R. (2018). Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. The Lancet, 391(10134), 2029–2035. DOI: https://doi.org/10.1016/S0140-6736(18)30667-6

Nyandekwe, M., Nzayirambaho, M., & Kakoma, J. B. (2020). Universal health insurance in Rwanda: Major challenges and solutions for financial sustainability case study of Rwanda community-based health insurance part I. Pan African Medical Journal, 37(1). https://doi.org/10.11604/pamj.2020.37.55.20376 DOI: https://doi.org/10.11604/pamj.2020.37.55.20376

Nyanza, E. C., Kapiga, S. H., Nsanya, M. K., Willkens, M., Cichowitz, C., & Peck, R. N. (2024). Exposure to toxic chemical elements among people living with HIV/AIDS in Northern Tanzania. Environmental Research, 260, 119645. https://doi.org/10.1016/j.envres.2024.119645 DOI: https://doi.org/10.1016/j.envres.2024.119645

Nyberg, S. T., Singh-Manoux, A., Pentti, J., Madsen, I. E., Sabia, S., Alfredsson, L., ... & Kivimäki, M. (2020). Association of healthy lifestyle with years lived without major chronic diseases. JAMA Internal Medicine, 180(5), 760–768. https://doi.org/10.1001/jamainternmed.2020.0618 DOI: https://doi.org/10.1001/jamainternmed.2020.0618

Obaya, H. E., Abdeen, H. A., Salem, A. A., Shehata, M. A., Aldhahi, M. I., Muka, T., ... & Atef, H. (2023). Effect of aerobic exercise, slow deep breathing and mindfulness meditation on cortisol and glucose levels in women with type 2 diabetes mellitus: A randomized controlled trial. Frontiers in Physiology, 14, 1186546. https://doi.org/10.3389/fphys.2023.1186546 DOI: https://doi.org/10.3389/fphys.2023.1186546

Obiero, K., Meulenbroek, P., Drexler, S., Dagne, A., Akoll, P., Odong, R., ... & Waidbacher, H. (2019). The contribution of fish to food and nutrition security in Eastern Africa: Emerging trends and future outlooks. Sustainability, 11(6), 1636. https://doi.org/10.3390/su11061636 DOI: https://doi.org/10.3390/su11061636

Osoro, O., Mbuthia, B., Nyawira, L., Githinji, J., & Gikonyo, S. (2024). Tanzania’s Universal Health Insurance Act, 2023: Implications on health financing.

Popkin, B. M., & Ng, S. W. (2022). The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra?processed foods is not inevitable. Obesity Reviews, 23(1), e13366. https://doi.org/10.1111/obr.13366 DOI: https://doi.org/10.1111/obr.13366

Pragholapati, A., Yosef, I., & Soemantri, I. (2020). The correlation of resilience with nurses work stress in emergency unit Rumah Sakit Al Islam (RSAI) Bandung. Sorume Health Sciences Journal, 1(1), 9–18.

Probst, J., Eberth, J. M., & Crouch, E. (2019). Structural urbanism contributes to poorer health outcomes for rural America. Health Affairs, 38(12), 1976–1984. https://doi.org/10.1377/hlthaff.2019.00914 DOI: https://doi.org/10.1377/hlthaff.2019.00914

Proper, K. I., & van Oostrom, S. H. (2019). The effectiveness of workplace health promotion interventions on physical and mental health outcomes – A systematic review of reviews. Scandinavian Journal of Work, Environment & Health, 45(6), 546–559. https://doi.org/10.5271/sjweh.3833 DOI: https://doi.org/10.5271/sjweh.3833

Qing, Y., Zheng, J., Tang, T., Li, S., Cao, S., Luo, Y., ... & Li, Y. (2023). Risk assessment of combined exposure to lead, cadmium, and total mercury among the elderly in Shanghai, China. Ecotoxicology and Environmental Safety, 256, 114874. https://doi.org/10.1016/j.ecoenv.2023.114874 DOI: https://doi.org/10.1016/j.ecoenv.2023.114874

Rane, M. A., Gitin, A., Fiedler, B., Fiedler, L., & Hennekens, C. H. (2020). Risks of cardiovascular disease and beyond in prescription of nonsteroidal anti-inflammatory drugs. Journal of Cardiovascular Pharmacology and Therapeutics, 25(1), 3–6. https://doi.org/10.1177/1074248419871902 DOI: https://doi.org/10.1177/1074248419871902

Reshmi, B., Unnikrishnan, B., Rajwar, E., Parsekar, S. S., Bhat, N., & George, A. (2019). Barriers and facilitators of hypertension management in India: A qualitative analysis. BMC Public Health, 19, 953. https://doi.org/10.1186/s12889-019-7266-0

Ruthsatz, M., & Candeias, V. (2020). Non-communicable disease prevention, nutrition and aging. Acta Bio Medica: Atenei Parmensis, 91(2), 379. https://doi.org/10.23750/abm.v91i2.9721

Samet, J. M., Fontham, E., Alpirez-Guardao, M., & Sousa-Santana, V. (2019). Pollution in the Americas: A leading cause of disease burden and an opportunity for cancer prevention. Salud Pública de México, 61(4), 417–426. https://doi.org/10.21149/9619 DOI: https://doi.org/10.21149/9619

Saqib, Z. A., Dai, J., Menhas, R., Mahmood, S., Karim, M., Sang, X., & Weng, Y. (2020). Physical activity is a medicine for non-communicable diseases: A survey study regarding the perception of physical activity impact on health wellbeing. Risk Management and Healthcare Policy, 13, 2949–2962. https://doi.org/10.2147/RMHP.S280339 DOI: https://doi.org/10.2147/RMHP.S280339

Saqlain, M., Munir, M. M., Rehman, S. U., Gulzar, A., Naz, S., Ahmed, Z., ... & Mashhood, M. (2020). Knowledge, attitude, practice and perceived barriers among healthcare workers regarding COVID-19: A cross-sectional survey from Pakistan. Journal of Hospital Infection, 105(3), 419–423. https://doi.org/10.1016/j.jhin.2020.05.007 DOI: https://doi.org/10.1016/j.jhin.2020.05.007

Schrepp, M. (2020). On the usage of Cronbach's alpha to measure reliability of UX scales. Journal of Usability Studies, 15(4).

Sharma, N., Kaushik, I., Bhushan, B., Gautam, S., & Khamparia, A. (2020). Applicability of WSN and biometric models in the field of healthcare. In Deep Learning Strategies for Security Enhancement in Wireless Sensor Networks (pp. 304–329). IGI Global. DOI: https://doi.org/10.4018/978-1-7998-5068-7.ch016

Shi, L., & Singh, D. A. (2022). Essentials of the US health care system. Jones & Bartlett Learning.

Smith, C. P., & Witter, N. S. (2002). Risk pooling and purchasing. Risk Pooling and Purchasing. https://www.researchgate.net/publication/366436809_Risk_Pooling_and_Purchasing_Risk_Pooling_and_Purchasing

Smith, C. P., & Witter, N. S. (2004). Risk pooling in health care financing: The implications for health system performance.

Srinivasagopalan, L. N. (2023). Advancing risk pooling mechanisms in healthcare coverage to strengthen system resilience and equity in modern health systems. Nanotechnology Perceptions, 19(2), 70–84. http://dx.doi.org/10.62441/nano-ntp.v19i2.4779

Subramanian, S., Gakunga, R., Kibachio, J., Gathecha, G., Edwards, P., Ogola, E., ... & EAEIG. (2018). Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors. PLOS ONE, 13(1), e0190113. https://doi.org/10.1371/journal.pone.0190113 DOI: https://doi.org/10.1371/journal.pone.0190113

Sun, Z., Gu, Q., Dai, Y., Zou, H., Agins, B., Chen, Q., ... & Jiang, H. (2022). Increasing awareness of HIV PrEP and willingness to use HIV PrEP among men who have sex with men: A systematic review and meta-analysis of global data. Journal of the International AIDS Society, 25(3), e25883. https://doi.org/10.1002/jia2.25883 DOI: https://doi.org/10.1002/jia2.25883

Sunarti, S., Ghozali, M. T., Haris, F., Rahman, F. F., & Rahman, R. A. (2020). Preventing fraud and deficit through the optimization of health insurance in Indonesia. Systematic Reviews in Pharmacy, 11(7).

Sürücü, L., & Maslakc?, A. (2020). Validity and reliability in quantitative research. Business & Management Studies: An International Journal, 8(3), 2694–2726. http://dx.doi.org/10.15295/bmij.v8i3.1540 DOI: https://doi.org/10.15295/bmij.v8i3.1540

Talbott, S. (2021). Mental Fitness: Maximizing Mood, Motivation, & Mental Wellness by Optimizing the Brain-body-biome. Turner Publishing Company.

Tangcharoensathien, V., Chandrasiri, O., Kunpeuk, W., Markchang, K., & Pangkariya, N. (2019). Addressing NCDs: Challenges from industry market promotion and interferences. International Journal of Health Policy and Management, 8(5), 256. https://doi.org/10.15171/ijhpm.2019.02 DOI: https://doi.org/10.15171/ijhpm.2019.02

Thyfault, J. P., & Bergouignan, A. (2020). Exercise and metabolic health: Beyond skeletal muscle. Diabetologia, 63(8), 1464–1474. https://doi.org/10.1007/s00125-020-05177-6 DOI: https://doi.org/10.1007/s00125-020-05177-6

Tain, Y. L., Li, L. C., Kuo, H. C., Chen, C. J., & Hsu, C. N. (2025). Gestational exposure to nonsteroidal anti-inflammatory drugs and risk of chronic kidney disease in childhood. JAMA Pediatrics, 179(2), 171–178. https://doi.org/10.1001/jamapediatrics.2024.4409 DOI: https://doi.org/10.1001/jamapediatrics.2024.4409

Tobin, D. G., Lockwood, M. B., Kimmel, P. L., Dember, L. M., Eneanya, N. D., Jhamb, M., ... & HOPE Consortium. (2022). Opioids for chronic pain management in patients with dialysis-dependent kidney failure. Nature Reviews Nephrology, 18(2), 113–128. https://doi.org/10.1038/s41581-021-00484-6 DOI: https://doi.org/10.1038/s41581-021-00484-6

Tortorella, G. L., Fogliatto, F. S., Mac Cawley Vergara, A., Vassolo, R., & Sawhney, R. (2020). Healthcare 4.0: Trends, challenges and research directions. Production Planning & Control, 31(15), 1245–1260. https://doi.org/10.1080/09537287.2019.1702226 DOI: https://doi.org/10.1080/09537287.2019.1702226

Tsai, F. J., Hu, Y. J., Chen, C. Y., Tseng, C. C., Yeh, G. L., & Cheng, J. F. (2021). Using the Health Belief Model to explore nursing students’ relationships between COVID-19 knowledge, health beliefs, cues to action, self-efficacy, and behavioral intention: A cross-sectional survey study. Medicine, 100(11), e25210. DOI: https://doi.org/10.1097/MD.0000000000025210

URT (2017). Formal Sector Employment and Earnings Survey: Tanzania Mainland. United Republic of Tanzania.

URT (2018). Annual Report for the Financial Year 2018/2019. National Health Insurance Fund.

URT (2019). Annual Report for the Financial Year 2019/2020. National Health Insurance Fund.

URT (2021). Annual Report for the Financial Year 2020/2021. National Health Insurance Fund.

URT (2022). Annual Report for the Financial Year 2021/2022. National Health Insurance Fund.

URT (2023). Annual Report for the Financial Year 2022/23. National Health Insurance Fund. https://nhif.or.tz/uploads/documents/sw-1736978854-sw1728653792-ANNUAL%20REPORT%202022.2023.pdf

Wang, R., Qiang, Y., Gao, X., Yang, Q., & Li, B. (2022). Prevalence of non-communicable diseases and its association with tobacco smoking cessation intention among current smokers in Shanghai, China. Tobacco Induced Diseases, 20. https://doi.org/10.18332/tid/155828 DOI: https://doi.org/10.18332/tid/155828

Wang, X., & Cheng, Z. (2020). Cross-sectional studies: Strengths, weaknesses, and recommendations. Chest, 158(1), S65–S71. https://doi.org/10.1016/j.chest.2020.03.012 DOI: https://doi.org/10.1016/j.chest.2020.03.012

Yip, W., Fu, H., Chen, A. T., Zhai, T., Jian, W., Xu, R., ... & Chen, W. (2019). 10 years of healthcare reform in China: Progress and gaps in universal health coverage. The Lancet, 394(10204), 1192–1204. DOI: https://doi.org/10.1016/S0140-6736(19)32136-1

Young, P. C. (2024). Public/private risk financing innovation: The case of government self-insurance risk pools in the United States. In Cross-Disciplinary Impacts on Insurance Law: ESG Concerns, Financial and Technological Innovation (pp. 89–125). Springer Nature. DOI: https://doi.org/10.1007/978-3-031-38526-1_5

Zhang, L., Xu, L. Y., Tang, F., Liu, D., Zhao, X. L., Zhang, J. N., ... & Ao, H. (2024). New perspectives on the therapeutic potential of quercetin in non-communicable diseases: Targeting Nrf2 to counteract oxidative stress and inflammation. Journal of Pharmaceutical Analysis, 14(6), 100930. https://doi.org/10.1016/j.jpha.2023.12.020 DOI: https://doi.org/10.1016/j.jpha.2023.12.020

Downloads

Published

2025-05-03

How to Cite

Kanyungu, S. (2025). The relationship between practical lifestyles and cost escalation over members’ contribution to health insurance in Tanzania: The mediation of non-communicable diseases. International Journal of Research in Business and Social Science (2147- 4478), 14(3), 398–417. https://doi.org/10.20525/ijrbs.v14i3.4051

Issue

Vol. 14 No. 3 (2025): April

Section

Related Topics in Social Science

License

Copyright (c) 2025 Salum Kanyungu

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

For all articles published in IJRBS, copyright is retained by the authors. Articles are licensed under an open access Creative Commons CC BY 4.0 license, meaning that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. These conditions allow for maximum use and exposure of the work, while ensuring that the authors receive proper credit.