Weldesenbet Adisu Birhanu, Kebede Sewnet Adem, Ayele Behailu Hawulte, Tusa Biruk Shalmeno
Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Clinicoecon Outcomes Res. 2021 Jul 28;13:693-701. doi: 10.2147/CEOR.S322087. eCollection 2021.
Despite improvement in access to modern healthcare services in East African countries, health-service delivery and health status of the population remained poor mainly due to the weak health-sector financing system. Therefore, the current study aimed to assess the health insurance coverage and its associated factors among reproductive-age group (RAG) women in East Africa.
The most recent (between 2010 and 2018) Demographic and Health Surveys (DHS) data of the ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe) were included. STATA version 16.0 statistical software was used for data processing and analysis. In the multilevel mixed-effects generalized linear model, variables with a p-value ≤0.05 were declared as significant associated factors of health insurance coverage.
The overall health insurance coverage in East Africa was 7.56% (95% CI: 7.42%, 7.77%). The odds of health insurance coverage were high among educated, currently working, and rich RAG women whereas it was low among rural residents. Besides, RAG women who have media exposure, visited by field workers, and visited health facilities have a higher chance of health insurance coverage.
Health insurance coverage in East Africa among RAG women was below ten percent. Educational status, working status, place of residence, wealth index, media exposure, visiting health facility within 12 months and being visited by field worker were significantly associated with health insurance coverage among RAG women in East Africa. Improving women's access to health facilities, promoting field workers' visit, and media exposure targeting uneducated, unemployed, and rural resident women of RAG will be a gateway to promote health insurance coverage.
尽管东非国家在获得现代医疗服务方面有所改善，但由于卫生部门融资系统薄弱，卫生服务提供情况和民众健康状况仍然不佳。因此，本研究旨在评估东非育龄妇女的健康保险覆盖情况及其相关因素。
纳入了十个东非国家（布隆迪、科摩罗、埃塞俄比亚、肯尼亚、马拉维、莫桑比克、坦桑尼亚、乌干达、赞比亚和津巴布韦）最新的（2010年至2018年期间）人口与健康调查（DHS）数据。使用STATA 16.0统计软件进行数据处理和分析。在多水平混合效应广义线性模型中，p值≤0.05的变量被视为健康保险覆盖的显著相关因素。
东非的总体健康保险覆盖率为7.56%（95%置信区间：7.42%，7.77%）。受过教育、目前有工作且富裕的育龄妇女获得健康保险的几率较高，而农村居民的几率较低。此外，接触过媒体、接受过实地工作人员家访以及去过医疗机构的育龄妇女获得健康保险的机会更高。
东非育龄妇女的健康保险覆盖率低于10%。教育程度、工作状况、居住地、财富指数、媒体接触、12个月内去过医疗机构以及接受实地工作人员家访与东非育龄妇女的健康保险覆盖显著相关。改善妇女获得医疗机构服务的机会、促进实地工作人员家访以及针对未受过教育、失业和农村居住的育龄妇女进行媒体宣传将是提高健康保险覆盖率的途径。
