Malik Amaama Abdul, Kaplan Muhittin
Economics Department, Ibn Haldun University, Istanbul, Turkey.
Health Econ Rev. 2025 Jul 10;15(1):58. doi: 10.1186/s13561-025-00629-4.
Health is a crucial component of an economy, influencing the performance of various sectors. As a result, nearly every country has implemented health policies to achieve the United Nations Development Goals and Universal Health Coverage (UHC) targets, which focus on providing universal access to necessary, sufficient, and quality healthcare without financial barriers. Implementing such policies in the sub-Saharan region led Burundi, Gabon, Ghana, and Rwanda to emerge as the only four countries in the region to have healthcare coverage over 20%. This study sought to investigate whether the health insurance policies implemented impact the wealth stratification of households in these countries.
The study used data from the sub-Saharan region section of the Demographic and Health Surveys (DHS) Program by the U.S. Agency for International Development (USAID) with Robust Ordered Probit Estimation Technique.
The results show that health insurance negatively impacts the Wealth levels of those in the poorest, poorer, and middle-income levels in Burundi and Rwanda more than those in the wealthiest group. Community-based insurance in Gabon and national health insurance in Ghana positively impact the income of lower households.
The government should improve social amenities, especially in rural areas. Also, the study identified limited information as one reason for the outcome. We propose increasing education on the importance of health and the benefit package when one subscribes to a health insurance scheme to encourage patronage and decrease out-of-pocket expenditure.
健康是经济的关键组成部分，影响着各个部门的表现。因此，几乎每个国家都实施了卫生政策，以实现联合国发展目标和全民健康覆盖（UHC）目标，这些目标侧重于在没有经济障碍的情况下提供普遍获得必要、充足和优质医疗保健的机会。在撒哈拉以南地区实施这些政策后，布隆迪、加蓬、加纳和卢旺达成为该地区仅有的四个医疗保健覆盖率超过20%的国家。本研究旨在调查所实施的健康保险政策是否会影响这些国家家庭的财富分层。
该研究使用了美国国际开发署（USAID）人口与健康调查（DHS）计划撒哈拉以南地区部分的数据，并采用了稳健有序概率估计技术。
结果表明，在布隆迪和卢旺达，健康保险对最贫困、较贫困和中等收入水平人群财富水平的负面影响大于对最富有群体的影响。加蓬的社区保险和加纳的国家健康保险对较低收入家庭的收入有积极影响。
政府应改善社会设施，特别是在农村地区。此外，该研究确定信息有限是导致这一结果的一个原因。我们建议增加关于健康重要性以及订阅健康保险计划时福利套餐的教育，以鼓励参保并减少自付费用。
