Planning and Development Department, Hangzhou Medical College, Hangzhou, Zhejiang, China.
School of Business, Central South University, Changsha, China.
PLoS One. 2022 Apr 12;17(4):e0264377. doi: 10.1371/journal.pone.0264377. eCollection 2022.
Promoting the coverage and ownership of health insurance constitutes a key strategy to achieving universal healthcare, thereby meeting the Sustainable Development Goal (SDG 3.8) of safeguarding the vulnerable population from financial risk resulting from catastrophic health expenditures. In sub-Saharan Africa, accessing medical services is particularly challenging among women due to inadequate opportunities for socio-economic empowerment and meeting their unique healthcare needs. The present study aimed to explore the sociodemographic factors associated with health insurance ownership among women in selected countries in sub-Saharan Africa.
We extracted cross-sectional data on health insurance ownership and conceptually relevant sociodemographic variables on women aged 15-49 years from Demographic and Health Surveys on five selected countries in sub-Saharan Africa (n = 55,438), including Burkina Faso, DR Congo, Cameroon, Gabon and Kenya. Data were analyzed using descriptive and multivariate regression analysis, and the associations were reported in terms of average marginal effects.
Data revealed considerable cross-country variation in health insurance ownership: Gabon (57.9%), Kenya (6.1%), DR Congo (2.8%), Cameroon (1.1%), Burkina Faso (0.4%). In the multivariate regression analysis, women's age, marital status, place of residency, educational level, household wealth status, employment, and media access were significant predictors of insurance ownership. The associations were generally similar across the five countries, with higher age, better educational level and wealth status showing a consistently positive relationship with insurance ownership.
Our findings revealed striking inequality in health insurance ownership among the studied countries, which should be given due attention to achieving universal healthcare-related goals. There also exist considerable sociodemographic disparities in health insurance ownership among women that should be addressed using context-specific programmatic interventions. Our findings revealed striking inequality in health insurance ownership among the studied countries, which should be given due attention to achieving universal healthcare-related goals. There also exist considerable sociodemographic disparities in health insurance ownership among women that should be addressed using context-specific programmatic interventions.
推广健康保险的覆盖范围和拥有率是实现全民医保的关键战略，从而实现保障弱势群体免受灾难性医疗支出导致的财务风险的可持续发展目标 3.8。在撒哈拉以南非洲，由于缺乏社会经济赋权机会和满足其独特的医疗保健需求的机会，妇女获得医疗服务尤其具有挑战性。本研究旨在探讨撒哈拉以南非洲选定国家中妇女拥有健康保险的社会人口因素。
我们从撒哈拉以南非洲五个选定国家（布基纳法索、刚果民主共和国、喀麦隆、加蓬和肯尼亚）的人口与健康调查中提取了关于 15-49 岁妇女健康保险拥有率和概念上相关的社会人口变量的横断面数据（n=55438）。数据采用描述性和多变量回归分析进行分析，并以平均边际效应报告关联。
数据显示，健康保险拥有率存在相当大的国家间差异：加蓬（57.9%）、肯尼亚（6.1%）、刚果民主共和国（2.8%）、喀麦隆（1.1%）、布基纳法索（0.4%）。在多变量回归分析中，妇女的年龄、婚姻状况、居住地点、教育程度、家庭财富状况、就业和媒体获取是保险拥有率的重要预测因素。这些关联在五个国家中基本相似，年龄较大、教育程度较高和财富状况较好与保险拥有率呈正相关。
我们的研究结果表明，在所研究的国家中，健康保险拥有率存在显著的不平等，这应该引起人们对实现与全民医保相关目标的关注。妇女的健康保险拥有率在社会人口方面也存在相当大的差异，应该通过具体情况具体的方案干预措施来解决。
