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

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  • 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
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    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.

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