Beyond Cash: Associations Between Social Security Benefits, Healthcare Accessibility, and Psychological Health Among Older Adults in Tanzania

Objectives Social security benefits are associated with better psychological health among older adults in resource-limited settings, yet the mechanisms underlying this association remain underexplored. We examined the role of healthcare accessibility in the relation between social security benefits and psychological health among older adults in Tanzania. Methods We analyzed cross-sectional data from a 2024 survey of Tanzanian adults aged 60 and above ( n = 2,012) in four geographic zones. We examined associations using structural equation modeling (SEM) with bias-corrected bootstrapping (5,000 replications). Social security benefits (combining pension and health insurance receipt), self-reported healthcare accessibility, and psychological health (a composite of anxiety and depression symptoms) were included as primary variables. Results Social security benefit receipt was significantly associated with better psychological health ( β = −0.106, BCCI: −0.152, −0.060, p < 0.001). Healthcare accessibility was positively associated with psychological health and showed a significant association with the relationship between social security benefits and psychological health ( β = −0.057, BCCI: −0.092, −0.022, p < 0.01), consistent with an indirect association in this cross-sectional analysis. Conclusions Healthcare accessibility plays a significant role in the relation between social security benefits and psychological health, suggesting a pathway through which social security benefits may influence psychological health beyond direct financial mechanisms. These findings point to potential policy considerations, including administrative coordination between pension and health insurance schemes and interventions to improve healthcare accessibility for older adults. For low- and middle-income countries facing rapid population aging, integrated approaches to social security benefits and health systems may help maximize the health returns of social investments.