Simiao Chen (
Pascal Geldsetzer, Stanford University, Stanford, California; and Chan Zuckerberg Biohub, San Francisco, California.
Health Aff (Millwood). 2022 Aug;41(8):1142-1152. doi: 10.1377/hlthaff.2021.00951.
This study aimed to determine levels of health insurance coverage in low- and middle-income countries and how coverage varies by people's sociodemographic characteristics. We conducted a population size-weighted, one-stage individual participant data meta-analysis of health insurance coverage, using a population-based sample of 2,035,401 participants ages 15-59 from nationally representative household surveys in fifty-six countries during the period 2006-18. One in five people (20.3 percent) across the fifty-six countries in our study had health insurance. Health insurance coverage exceeded 50 percent in only seven countries and 70 percent in only three countries. Substantially more people had public health insurance than private health insurance (71.4 percent versus 28.6 percent). We found that men and older, more educated, and wealthier people were more likely to have health insurance; these sociodemographic gradients in health insurance coverage were strongest in sub-Saharan Africa and followed traditional lines of privilege. Low- and middle-income countries need to massively expand health insurance coverage if they intend to use insurance to achieve universal health coverage.
这项研究旨在确定中低收入国家的健康保险覆盖水平，以及覆盖范围如何因人们的社会人口特征而有所不同。我们对健康保险覆盖情况进行了人口规模加权的、基于单个参与者数据的荟萃分析，使用了来自 56 个国家在 2006 年至 2018 年期间进行的基于人群的、具有代表性的家庭调查中 2035401 名 15 至 59 岁参与者的数据。在我们的研究中，56 个国家中有五分之一（20.3%）的人有健康保险。只有七个国家的健康保险覆盖率超过 50%，只有三个国家的健康保险覆盖率超过 70%。有更多的人拥有公共健康保险而不是私人健康保险（71.4%比 28.6%）。我们发现，男性和年龄较大、受教育程度较高、较富裕的人更有可能拥有健康保险；在撒哈拉以南非洲地区，健康保险覆盖范围的这种社会人口梯度最为明显，其次是传统的特权阶层。如果中低收入国家打算利用保险实现全民健康覆盖，就需要大规模扩大健康保险覆盖范围。
