Moderation effects of co-operative institutions' capabilities on the relationship between health insurance literacy and participation in health insurance among co-operative members in Tanzania

The rationality of the decision to use health insurance depends on the individuals' level of health insurance literacy (HIL). HIL facilitates health information-seeking behaviour among individuals and helps providers and intermediaries offer clients timely and suitable health insurance. This study adopted the institutional theory of organisations as the theoretical lens to analyse the relationship between HIL and participation in health insurance amongst members of co-operatives. The study also assessed the moderation effect of co-operative institutions' capabilities on the relationship between HIL and participation in health insurance among co-operative members. Using the sample of 480 co-operative members, partial least squares structural equation modelling was used to test for the direct influence of HIL on participation in Ushirika Afya health insurance and the moderation role of co-operative institutions' capabilities in this relationship. Findings indicate that HIL is a significant factor influencing participation in health insurance, particularly in Ushirika Afya. On the moderation effect, the link between HIL and participation in Ushirika Afya health insurance is strong when the co-operative institutions' capabilities level is high. It weakens when the institutions' capabilities level is low. For sustainable participation in health insurance among co-operative members, it is crucial to formulate awareness programmes and continuous training to increase HIL. Moreover, to build strong co-operative institutional capabilities, there is a need to increase initiatives in such aspects as management training in various dimensions relating to health insurance operations.