Health insurance and the distribution of healthcare use in Rwanda’s Vision Umurenge Programme
Evidence from the Seventh Integrated Household Living Conditions Survey
Bibliographic Data
| ID | 19530490 |
|---|---|
| Authors | Jean de Dieu Harerimana (0000-0002-2099-6656, Clinton Health Access Initiative, corresponding author) |
| Year | 2026 |
| Volume | 19 |
| Issue | 1 |
| Pages | 2641401-2641401 |
| Publication date | 2026-12-31 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Global Health Action (JOURNAL) |
| Journal identifiers | ISSN: 1654-9716 • E-ISSN: 1654-9880 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/16549716.2026.2641401 |
| PMID | 41804591 |
| OpenAlex | W7134853500 |
| Language | EN |
| References cited | 24 |
BACKGROUND: Rwanda's community-based health insurance (CBHI) has achieved near-universal enrollment, yet inequities in healthcare use remain. Understanding whether coverage translates into equitable utilization is critical for advancing universal health coverage (UHC). This study aims to examine how social protection complements health insurance in promoting equitable healthcare access. OBJECTIVE: To examine the relationship between insurance coverage and healthcare utilization in sectors targeted by the Vision Umurenge Programme (VUP), assess socioeconomic inequities, and evaluate the complementary role of social protection. METHODS: This study analyzed cross-sectional data from 15,039 households in VUP sectors using the 2023-2024 Seventh Integrated Household Living Conditions Survey. Socioeconomic inequality was measured using Erreygers-corrected concentration indices and need-standardized horizontal inequity analysis. Insurance effects were estimated using survey weighted logistic regression, propensity score matching, and doubly robust inverse-probability-weighted regression adjustment. RESULTS: Insurance coverage was 85.8%, yet only 25.5% reported any formal healthcare utilization in the 12 months preceding the survey, including outpatient visits, inpatient admissions and preventive services. Utilization showed stronger pro-rich concentration (E = +0.066) than coverage (E = +0.026) and need-standardized analysis confirmed residual inequity. Insurance increased utilization by +14.6% points in regression models and ~+12% points in causal estimators. Participation in VUP components, particularly direct support, was consistently associated with higher service use. CONCLUSIONS: In a high coverage setting, persistent pro-rich inequities highlight the role of non-financial barriers such as indirect costs and service readiness. Layering social protection with insurance and strengthening primary care delivery is critical to convert nominal coverage into equitable healthcare access
Distribution (mathematics) · Health care · Health insurance · Health services · Healthcare delivery · Service (business) · Service delivery framework · Agricultural risk and resilience · Global Maternal and Child Health · Healthcare Systems and Reforms
Income Inequality and Health
Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries
Cash transfer, maternal and child health outcomes
Strategies for financing social health insurance schemes for providing universal health care
Assessing national and subnational inequalities in medical care utilization and financial risk protection in Rwanda
Socioeconomic inequality in premiums for a community-based health insurance scheme in Rwanda
The impact of health insurance on maternal health care utilization
Community-Based Health Financing and Child Stunting in Rural Rwanda
| Citation velocity | historical |
|---|---|
| Highly cited | No |