IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v119y2015i9p1164-1175.html
   My bibliography  Save this article

Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries

Author

Listed:
  • El-Sayed, Abdulrahman M.
  • Palma, Anton
  • Freedman, Lynn P.
  • Kruk, Margaret E.

Abstract

Non-communicable diseases (NCDs) are the greatest contributor to morbidity and mortality in low- and middle-income countries (LMICs). However, NCD care is limited in LMICs, particularly among the disadvantaged and rural. We explored the role of insurance in mitigating socioeconomic and urban–rural disparities in NCD treatment across 48 LMICs included in the 2002–2004 World Health Survey (WHS). We analyzed data about ever having received treatment for diagnosed high-burden NCDs (any diagnosis, angina, asthma, depression, arthritis, schizophrenia, or diabetes) or having sold or borrowed to pay for healthcare. We fit multivariable regression models of each outcome by the interaction between insurance coverage and household wealth (richest 20% vs. poorest 50%) and urbanicity, respectively. We found that insurance was associated with higher treatment likelihood for NCDs in LMICs, and helped mitigate socioeconomic and regional disparities in treatment likelihood. These influences were particularly strong among women. Insurance also predicted lower likelihood of borrowing or selling to pay for health services among the poorest women. Taken together, insurance coverage may serve as an important policy tool in promoting NCD treatment and in reducing inequities in NCD treatment by household wealth, urbanicity, and sex in LMICs.

Suggested Citation

  • El-Sayed, Abdulrahman M. & Palma, Anton & Freedman, Lynn P. & Kruk, Margaret E., 2015. "Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries," Health Policy, Elsevier, vol. 119(9), pages 1164-1175.
    • Handle: RePEc:eee:hepoli:v:119:y:2015:i:9:p:1164-1175
    DOI: 10.1016/j.healthpol.2015.07.006
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851015001840
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2015.07.006?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Belli, Paolo, 2001. "How adverse selection affects the health insurance market," Policy Research Working Paper Series 2574, The World Bank.
    2. Haddad, Slim & Fournier, Pierre, 1995. "Quality, cost and utilization of health services in developing countries. A longitudinal study in Zaïre," Social Science & Medicine, Elsevier, vol. 40(6), pages 743-753, March.
    3. Matthew Jowett & Anil Deolalikar & Peter Martinsson, 2004. "Health insurance and treatment seeking behaviour: evidence from a low‐income country," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 845-857, September.
    4. Wagstaff, Adam & Pradhan, Menno, 2005. "Health insurance impacts on health and nonmedical consumption in a developing country," Policy Research Working Paper Series 3563, The World Bank.
    5. Duncan Thomas, 1990. "Intra-Household Resource Allocation: An Inferential Approach," Journal of Human Resources, University of Wisconsin Press, vol. 25(4), pages 635-664.
    6. Wagner, Anita K. & Graves, Amy Johnson & Reiss, Sheila K. & LeCates, Robert & Zhang, Fang & Ross-Degnan, Dennis, 2011. "Access to care and medicines, burden of health care expenditures, and risk protection: Results from the World Health Survey," Health Policy, Elsevier, vol. 100(2), pages 151-158.
    7. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    8. World Bank, 2003. "World Development Indicators 2003," World Bank Publications - Books, The World Bank Group, number 13920.
    9. Sukumar Vellakkal & S V Subramanian & Christopher Millett & Sanjay Basu & David Stuckler & Shah Ebrahim, 2013. "Socioeconomic Inequalities in Non-Communicable Diseases Prevalence in India: Disparities between Self-Reported Diagnoses and Standardized Measures," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-12, July.
    10. Wagner, Anita K. & Graves, Amy Johnson & Reiss, Sheila K. & LeCates, Robert & Zhang, Fang & Ross-Degnan, Dennis, 2011. "Access to care and medicines, burden of health care expenditures, and risk protection: Results from the World Health Survey," Health Policy, Elsevier, vol. 100(2-3), pages 151-158, May.
    11. Abdallah S. Daar & Peter A. Singer & Deepa Leah Persad & Stig K. Pramming & David R. Matthews & Robert Beaglehole & Alan Bernstein & Leszek K. Borysiewicz & Stephen Colagiuri & Nirmal Ganguly & Roger , 2007. "Grand challenges in chronic non-communicable diseases," Nature, Nature, vol. 450(7169), pages 494-496, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Durr-e-Nayab & Shujaat Farooq & Nabila Kunwal, 2024. "Utilisation Challenges of Public Health Insurance Initiatives: Evidences from Sehat Sahulat Programme (SSP) in Pakistan (Policy)," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 63(2), pages 247-288.
    2. Tien Thanh, Pham & Bao Duong, Pham, 2022. "The economic burden of non-communicable diseases on households and their coping mechanisms: Evidence from rural Vietnam," World Development, Elsevier, vol. 151(C).
    3. Tess Bright & Sarah Wallace & Hannah Kuper, 2018. "A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries," IJERPH, MDPI, vol. 15(10), pages 1-34, October.
    4. Sumaiyah Docrat & Donela Besada & Susan Cleary & Crick Lund, 2020. "The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic re," Health Economics Review, Springer, vol. 10(1), pages 1-23, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Bereket Yakob & Busisiwe Purity Ncama, 2016. "Correlates of perceived access and implications for health system strengthening – lessons from HIV/AIDS treatment and care services in Ethiopia," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-19, August.
    2. Richard Agbanyo, 2020. "Ghana's national health insurance, free maternal healthcare and facility‐based delivery services," African Development Review, African Development Bank, vol. 32(1), pages 27-41, March.
    3. Richard Agbanyo & James Atta Peprah, 2021. "National health insurance and the choice of delivery facility among expectant mothers in Ghana," International Journal of Health Economics and Management, Springer, vol. 21(1), pages 27-49, March.
    4. Maryam Bigdeli & Bart Jacobs & Chean Rithy Men & Kristine Nilsen & Wim Van Damme & Bruno Dujardin, 2016. "Access to Treatment for Diabetes and Hypertension in Rural Cambodia: Performance of Existing Social Health Protection Schemes," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-18, January.
    5. Tanika Chakraborty & Prabal K. De, 2017. "Mother’s autonomy and child’s secondary schooling enrollment in Mexico," Review of Economics of the Household, Springer, vol. 15(3), pages 1037-1053, September.
    6. A Khan & M Prince & C Brayne & A M Prina, 2015. "Lifetime Prevalence and Factors Associated with Head Injury among Older People in Low and Middle Income Countries: A 10/66 Study," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-14, July.
    7. Sözmen, Kaan & Ünal, Belgin, 2016. "Explaining inequalities in Health Care Utilization among Turkish adults: Findings from Health Survey 2008," Health Policy, Elsevier, vol. 120(1), pages 100-110.
    8. Fan, Victoria Y. & Savedoff, William D., 2014. "The health financing transition: A conceptual framework and empirical evidence," Social Science & Medicine, Elsevier, vol. 105(C), pages 112-121.
    9. Schultz, T. Paul, 2010. "Population and Health Policies," Handbook of Development Economics, in: Dani Rodrik & Mark Rosenzweig (ed.), Handbook of Development Economics, edition 1, volume 5, chapter 0, pages 4785-4881, Elsevier.
    10. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    11. Krishna Dipankar Rao & David H. Peters, 2007. "Quality improvement and its impact on the use and equality of outpatient health services in India," Health Economics, John Wiley & Sons, Ltd., vol. 16(8), pages 799-813, August.
    12. Julia A. Behrman, 2020. "Mother’s Relative Educational Status and Early Childhood Height-for-Age z Scores: A Decomposition of Change Over Time," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 39(1), pages 147-173, February.
    13. Echeverría, Lucía & Menon, Martina & Perali, Federico & Berges, Miriam, 2019. "Intra-household inequality and child welfare in Argentina," Nülan. Deposited Documents 3051, Universidad Nacional de Mar del Plata, Facultad de Ciencias Económicas y Sociales, Centro de Documentación.
    14. Stella A. Quimbo & John W. Peabody & Riti Shimkhada & Jhiedon Florentino & Orville Solon, 2011. "Evidence of a causal link between health outcomes, insurance coverage, and a policy to expand access: experimental data from children in the Philippines," Health Economics, John Wiley & Sons, Ltd., vol. 20(5), pages 620-630, May.
    15. Menon, Nidhiya & van der Meulen Rodgers, Yana & Nguyen, Huong, 2014. "Women’s Land Rights and Children’s Human Capital in Vietnam," World Development, Elsevier, vol. 54(C), pages 18-31.
    16. Behrman, Jere R., 2010. "Investment in Education Inputs and Incentives," Handbook of Development Economics, in: Dani Rodrik & Mark Rosenzweig (ed.), Handbook of Development Economics, edition 1, volume 5, chapter 0, pages 4883-4975, Elsevier.
    17. Samuel S. Lieberman & Adam Wagstaff, 2009. "Health Financing and Delivery in Vietnam : Looking Forward," World Bank Publications - Books, The World Bank Group, number 2594.
    18. Pablo Gottret & George J. Schieber & Hugh R. Waters, 2008. "Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income Countries," World Bank Publications - Books, The World Bank Group, number 6442.
    19. Aurino, Elisabetta & Lleras-Muney, Adriana & Tarozzi, Alessandro & Tinoco, Brendan, 2023. "The rise and fall of SES gradients in heights around the world," Journal of Health Economics, Elsevier, vol. 91(C).
    20. Echeverría, Lucía, 2020. "Modelos colectivos de consumo y distribución intra-hogar. Teoría y aplicaciones," Nülan. Deposited Documents 3832, Universidad Nacional de Mar del Plata, Facultad de Ciencias Económicas y Sociales, Centro de Documentación.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:119:y:2015:i:9:p:1164-1175. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.