Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries.
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.
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA. Electronic address: ame2145@columbia.edu.
Abdulrahman M
AM
El-Sayed
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
Anton
A
Palma
Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
Lynn P
LP
Freedman
Department of Global Health & Population, Chan School of Public Health, Harvard University, 665 Huntington Ave., Rm 1115, Boston, MA 02115, USA.
Margaret E
ME
Kruk
D000328:Adult; D002908:Chronic Disease / Q000628:therapy; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008297:Male; D012959:Socioeconomic Factors
Health disparities; Health insurance; Healthcare; Low and middle income countries; Non-communicable diseases