The effect of health insurance coverage on antenatal care utilization in Cambodia: A secondary analysis of Cambodia Demographic and Health Survey 2021-2022.

Health insurance is essential in reducing or eliminating the financial constraint to accessing maternal health services caused by out-of-pocket payments. Also, it has a beneficial effect in minimizing maternal and child mortality. However, limited studies in Cambodia examined the association between health insurance coverage on antenatal care (ANC) utilization. Therefore, this study has examined the effect of health insurance coverage on ANC utilization in Cambodia. We utilized data from the 2021-2022 Cambodia Demographic and Health Surveys (CDHS), analyzing a total sample of 3,162 weighted women who gave birth within two years. Multiple logistic regression model using STATA V17 to assess the association between health insurance coverage with women who attended four or more ANC visits. About 24.9% of the women had health insurance coverage during 2021-2022. Most (86.1%) of women attended four or more ANC visits. Women with health insurance coverage were statistically significantly associated with attending four or more ANC visits with an adjusted odds ratio (AOR = 1.6; 95% CI: 1.1-2.4). Other factors significantly associated with attending four or more ANC visits include women with higher education (AOR = 3.1; 95% CI: 1.2-7.7), secondary education (AOR = 2.3; 95% CI: 1.5-3.5), richest households (AOR = 3.2; 95% CI: 1.5-6.8), and richer households (AOR = 1.9; 95% CI: 1.2-2.8). Pregnant women with health insurance coverage who had completed at least secondary education and had a better wealth index were more likely to attend at least four ANC visits. Thus, providing health insurance coverage and improving women's economic and educational may be essential to improving women's access to maternal health services in Cambodia.