Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries

Bibliographic Data

ID21881303
AuthorsEdwine Barasa (0000-0001-5793-7177, Kenya Medical Research Institute, corresponding author), Jacob Kazungu (0000-0002-3138-7274, Kenya Medical Research Institute), Peter Nguhiu (0000-0002-0875-0549, Kenya Medical Research Institute), Nirmala Ravishankar (0009-0002-7005-3389, Stratetic purchasing for PHC, Thinkwell, Washington, District of Columbia, USA)
Year2021
Volume6
Issue4
Pagese004712
Publication date2021-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2020-004712
PMID33903176
OpenAlexW3159717852
LanguageEN
Citations received49
References cited25

INTRODUCTION: Low/middle-income countries (LMICs) in sub-Saharan Africa (SSA) are increasingly turning to public contributory health insurance as a mechanism for removing financial barriers to access and extending financial risk protection to the population. Against this backdrop, we assessed the level and inequality of population coverage of existing health insurance schemes in 36 SSA countries. METHODS: Using secondary data from the most recent Demographic and Health Surveys, we computed mean population coverage for any type of health insurance, and for specific forms of health insurance schemes, by country. We developed concentration curves, computed concentration indices, and rich-poor differences and ratios to examine inequality in health insurance coverage. We decomposed the concentration index using a generalised linear model to examine the contribution of household and individual-level factors to the inequality in health insurance coverage. RESULTS: Only four countries had coverage levels with any type of health insurance of above 20% (Rwanda-78.7% (95% CI 77.5% to 79.9%), Ghana-58.2% (95% CI 56.2% to 60.1%), Gabon-40.8% (95% CI 38.2% to 43.5%), and Burundi 22.0% (95% CI 20.7% to 23.2%)). Overall, health insurance coverage was low (7.9% (95% CI 7.8% to 7.9%)) and pro-rich; concentration index=0.4 (95% CI 0.3 to 0.4, p<0.001). Exposure to media made the greatest contribution to the pro-rich distribution of health insurance coverage (50.3%), followed by socioeconomic status (44.3%) and the level of education (41.6%). CONCLUSION: Coverage of health insurance in SSA is low and pro-rich. The four countries that had health insurance coverage levels greater than 20% were all characterised by substantial funding from tax revenues. The other study countries featured predominantly voluntary mechanisms. In a context of high informality of labour markets, SSA and other LMICs should rethink the role of voluntary contributory health insurance and instead embrace tax funding as a sustainable and feasible mechanism for mobilising resources for the health sector

Actuarial science · Business · Demographic economics · Developing country · Economic growth · Economics · Environmental health · Geography · Inequality · Population · Public health · Socioeconomic status · Sociology · Demography · Healthcare Policy and Management · Healthcare Systems and Reforms · Mathematics · Medicine · Primary Care and Health Outcomes

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