Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
PLoS One. 2022 Mar 4;17(3):e0264162. doi: 10.1371/journal.pone.0264162. eCollection 2022.
With the vision of achieving Universal Health Coverage (UHC) by the year 2030, many sub-Saharan African (SSA) countries have implemented health insurance schemes that seek to improve access to healthcare for their populace. In this study, we examined the prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa (SSA).
We used the most recent Demographic and Health Survey (DHS) data from 23 countries in SSA. We included 120,037 women and 54,254 men residing in urban centres in our analyses which were carried out using both bivariable and multivariable analyses.
We found that the overall prevalence of health insurance coverage was 10.6% among females and 14% among males. The probability of being covered by health insurance increased by level of education. Men and women with higher education, for instance, had 7.61 times (95%CI = 6.50-8.90) and 7.44 times (95%CI = 6.77-8.17) higher odds of being covered by health insurance than those with no formal education. Males and females who read newspaper or magazine (Males: AOR = 1.47, 95%CI = 1.37-1.57; Females: AOR = 2.19, 95%CI = 1.31-3.66) listened to radio (Males: AOR = 1.29, 95%CI = 1.18-1.41; Females: AOR = 1.42, 95%CI = 1.35-1.51), and who watched television (Males: AOR = 1.80, 95%CI = 1.64-1.97; Females: AOR = 1.86, 95%CI = 1.75-1.99) at least once a week had higher odds of being covered by health insurance.
The coverage of health insurance in SSA is generally low among urban dwellers. This has negative implications for the achievement of universal health coverage by the year 2030. We recommend increased public education on the benefits of being covered by health insurance using the mass media which we found to be an important factor associated with health insurance coverage. The focus of such mass media education could target the less educated urban dwellers, males in the lowest wealth quintile, and young adults (15-29 years).
为了在 2030 年实现全民健康覆盖的愿景，许多撒哈拉以南非洲（SSA）国家实施了医疗保险计划，旨在改善其民众获得医疗保健的机会。在这项研究中，我们调查了撒哈拉以南非洲城市地区医疗保险覆盖的流行率及其相关因素。
我们使用了来自 SSA 23 个国家的最新人口与健康调查（DHS）数据。我们分析了居住在城市中心的 120037 名女性和 54254 名男性，使用单变量和多变量分析进行了分析。
我们发现，女性的医疗保险覆盖率总体为 10.6%，男性为 14%。医疗保险覆盖的可能性随着教育水平的提高而增加。例如，受过高等教育的男性和女性，其医疗保险覆盖率比没有正规教育的男性和女性高 7.61 倍（95%CI = 6.50-8.90）和 7.44 倍（95%CI = 6.77-8.17）。男性和女性中，阅读报纸或杂志的人（男性：AOR = 1.47，95%CI = 1.37-1.57；女性：AOR = 2.19，95%CI = 1.31-3.66）、听广播的人（男性：AOR = 1.29，95%CI = 1.18-1.41；女性：AOR = 1.42，95%CI = 1.35-1.51）和看电视的人（男性：AOR = 1.80，95%CI = 1.64-1.97；女性：AOR = 1.86，95%CI = 1.75-1.99），其医疗保险覆盖率更高。
撒哈拉以南非洲城市居民的医疗保险覆盖率普遍较低。这对 2030 年实现全民健康覆盖的目标有负面影响。我们建议利用大众媒体加强医疗保险好处的公共教育，我们发现这是与医疗保险覆盖相关的一个重要因素。这种大众媒体教育的重点可以针对教育程度较低的城市居民、最低财富五分位数的男性和年轻人（15-29 岁）。
