Singh Nishikant, John Pratheeba, Shukla Sudheer Kumar, Bajpai Rimjhim, Sengupta Rituparna, Sadanandan Rajeev, Singh Navin
Health Systems Transformation Platform, New Delhi, India.
Population Council Consulting Private Limited, New Delhi, India.
Lancet Reg Health Southeast Asia. 2025 Jul 11;39:100634. doi: 10.1016/j.lansea.2025.100634. eCollection 2025 Aug.
Equitable access to quality healthcare without financial hardship is key to achieving Universal Health Coverage (UHC), especially in low- and middle-income countries in the WHO Southeast Asia Region (SEAR). Despite health insurance programmes, high out-of-pocket expenditures remain a barrier. This study evaluates health insurance coverage in SEAR, analysing socioeconomic and demographic factors.
This cross-sectional study used data from Demographic and Health Surveys (2015-2022) conducted in countries within the SEAR (data from six countries for women and five for men). Our analysis separately examined women and men aged 15-49 years using data from their respective individual Demographic and Health Survey datasets. Pooled estimates of health insurance coverage were calculated with 95% CI. Multilevel logistic regression quantified variations at the country and community-levels and identified factors influencing health insurance uptake.
Health insurance coverage varied across SEAR, with Indonesia reporting highest for women (58.2%; 95% CI: 57.65-58.72) and men (56.6%; 95% CI: 55.31-57.88), while lowest in Bangladesh for women (0.3%; 95% CI: 0.22-0.39) and Myanmar for men (1.4%; 95% CI: 1.04-1.83). Indonesia also had highest social security health insurance (women: 31.0%; 95% CI: 30.49-31.49, men: 27.9%; 95% CI: 26.74-29.03). Private insurance was lowest in Myanmar (women: 0.6%; 95% CI: 0.42-0.72, men: 0.9%; 95% CI: 0.60-1.27) and highest in Indonesia (women: 28.0%; 95% CI: 27.54-28.5, men: 30.0%; 95% CI: 28.81-31.14). Health insurance coverage was higher among individuals with higher education, greater exposure to mass media, rural residence, and older age. Insurance uptake was influenced by contextual factors beyond individual characteristics. India had highest community-attributable variation in health insurance uptake [women (53.1%; 95% CI: 52.56-53.62); men (56.3%; 95% CI: 55.17-57.46)], while lowest in Indonesia among women (17.7%; 95% CI: 16.40-18.99) and Maldives among men (10.8%; 95% CI: 6.71-16.84), after adjusting for demographic and socioeconomic factors.
With an ageing population, healthcare demand and costs in SEAR will rise. Context-specific health insurance policies and targeted interventions are crucial for bridging coverage gaps and achieving UHC.
There is no specific funding for this study.
在不造成经济困难的情况下公平获得优质医疗保健是实现全民健康覆盖（UHC）的关键，尤其是在世卫组织东南亚区域（SEAR）的低收入和中等收入国家。尽管有医疗保险计划，但高额的自付费用仍然是一个障碍。本研究评估了东南亚区域的医疗保险覆盖情况，分析了社会经济和人口因素。
这项横断面研究使用了在东南亚区域各国进行的人口与健康调查（2015 - 2022年）的数据（女性数据来自六个国家，男性数据来自五个国家）。我们的分析分别使用各自个人人口与健康调查数据集的数据，对15 - 49岁的女性和男性进行了研究。计算了医疗保险覆盖的合并估计值及95%置信区间。多级逻辑回归量化了国家和社区层面的差异，并确定了影响医疗保险参保率的因素。
东南亚区域各国的医疗保险覆盖情况各不相同，印度尼西亚女性的参保率最高（58.2%；95%置信区间：57.65 - 58.72），男性参保率最高（56.6%；95%置信区间：55.31 - 57.88），而孟加拉国女性参保率最低（0.3%；95%置信区间：0.22 - 0.39），缅甸男性参保率最低（1.4%；95%置信区间：1.04 - 1.83）。印度尼西亚的社会保障医疗保险参保率也最高（女性：31.0%；95%置信区间：30.49 - 31.49，男性：27.9%；95%置信区间：26.74 - 29.03）。缅甸的私人保险参保率最低（女性：0.6%；95%置信区间：0.42 - 0.72，男性：0.9%；95%置信区间：0.60 - 1.27），印度尼西亚的私人保险参保率最高（女性：28.0%；95%置信区间：27.54 - 28.5，男性：30.0%；95%置信区间：28.81 - 31.14）。受过高等教育、更多接触大众媒体、居住在农村以及年龄较大的人群医疗保险覆盖情况更高。保险参保率受到个体特征之外的背景因素影响。在调整了人口和社会经济因素后，印度在医疗保险参保率方面社区归因差异最高[女性（53.1%；95%置信区间：52.56 - 53.62）；男性（56.3%；95%置信区间：55.17 - 57.46）]，而印度尼西亚女性中该差异最低（17.7%；95%置信区间：16.40 - 18.99），马尔代夫男性中该差异最低（10.8%；95%置信区间：6.71 - 16.84）。
随着人口老龄化，东南亚区域的医疗保健需求和成本将会上升。因地制宜的医疗保险政策和有针对性的干预措施对于弥合覆盖差距和实现全民健康覆盖至关重要。
本研究没有特定资金来源。
