Health insurance coverage, neonatal mortality and caesarean section deliveries: an analysis of vital registration data in Colombia.
Low-income and middle-income countries have introduced different health insurance schemes over the past decades, but whether different schemes are associated with different neonatal outcomes is yet unknown. We examined the association between the health insurance coverage scheme and neonatal mortality in Colombia.



We used Colombian national vital registration data, including all live births (2 506 920) and neonatal deaths (17 712) between 2008 and 2011. We used Poisson regression models to examine the association between health insurance coverage and the neonatal mortality rate (NMR), distinguishing between women insured via the contributory scheme (40% of births, financed through payroll and employer's contributions), government subsidised insurance (47%) and the uninsured (11%).



NMR was lower among babies born to mothers in the contributory scheme (6.13/1000) than in the subsidised scheme (7.69/1000) or the uninsured (8.38/1000). Controlling for socioeconomic and demographic factors, NMRs remained higher for those in the subsidised scheme (OR 1.09, 95% CI 1.05 to 1.14) and the uninsured (OR 1.16, 95% CI 1.10 to 1.23) compared to those in the contributory scheme. These differences increased in models that additionally controlled for caesarean section (C-section) delivery. This increase was due to the higher fraction of C-section deliveries among women in the contributory scheme (49%, compared to 34% for the subsidised scheme and 28% for the uninsured).



Health insurance through the contributory system is associated with lower neonatal mortality than insurance through the subsidised system or lack of insurance. Universal health insurance may not be sufficient to close the gap in newborn mortality between socioeconomic groups.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Institute for Global Health-University College London, London, UK.
Tanja A J
TA
Houweling
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.|Department of Specific Sciences, National School of Public Health, University of Antioquia, Medellin, Antioquia, Colombia.
Ivan
I
Arroyave
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Alex
A
Burdorf
Department of Global Health & Social Medicine, King's College London, London, UK.|Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Mauricio
0000-0002-7295-2911
M
Avendano
D002585:Cesarean Section / Q000706:statistics & numerical data; D003105:Colombia; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D012042:Registries; D012307:Risk Factors
BIRTH WEIGHT; HEALTH POLICY; Health inequalities; MORTALITY; NEONATAL