Skip to main content
Top
Published in: International Journal of Public Health 1/2019

01-01-2019 | Original Article

Health inequality and community-based health insurance: a case study of rural Rwanda with repeated cross-sectional data

Authors: Kai Liu, Benjamin Cook, Chunling Lu

Published in: International Journal of Public Health | Issue 1/2019

Login to get access

Abstract

Objectives

To investigate the inequality in medical care utilization and household catastrophic health spending (HCHS) between the poverty and non-poverty residents in rural Rwanda and their links with community-based health insurance (Mutuelles).

Methods

We used the 2005 and 2010 nationally representative Integrated Living Conditions Surveys. We estimated multilevel logistic regression models to obtain the adjusted levels and trends of both absolute and relative inequalities and examined associations between Mutuelles status and these inequalities.

Results

Significant inequality between the two income groups, in both absolute and relative measures of medical care utilization and HCHS remained unchanged in 2005 and 2010. Significant reduction in adjusted absolute inequality in percentage of HCHS between the two years was not associated with Mutuelles status.

Conclusions

While Mutuelles promoted medical care utilization and reduced HCHS, it did not play a significant role in reducing their inequalities by poverty status between 2005 and 2010. Future studies should assess the impact of additional strategies (e.g., the exemption of Mutuelles premiums and copayments for households living in poverty), on reducing inequality by poverty status.
Appendix
Available only for authorised users
Literature
go back to reference Braveman P, Gruskin S (2003a) Defining equity in health. J Epidemiol Commun H 57:254–258CrossRef Braveman P, Gruskin S (2003a) Defining equity in health. J Epidemiol Commun H 57:254–258CrossRef
go back to reference Braveman P, Gruskin S (2003b) Poverty, equity, human rights and health B World Health. Organ 81:539–545 Braveman P, Gruskin S (2003b) Poverty, equity, human rights and health B World Health. Organ 81:539–545
go back to reference Hidayat B, Thabrany H, Dong H, Sauerborn R (2004) The effects of mandatory health insurance on equity in access to outpatient care in Indonesia. Health Policy Plan 19:322–335CrossRefPubMed Hidayat B, Thabrany H, Dong H, Sauerborn R (2004) The effects of mandatory health insurance on equity in access to outpatient care in Indonesia. Health Policy Plan 19:322–335CrossRefPubMed
go back to reference Lu C, Chin B, Lewandowski JL et al (2012) Towards universal health coverage: an evaluation of rwanda Mutuelles in its first eight years. Plos One 7:e39282CrossRefPubMedPubMedCentral Lu C, Chin B, Lewandowski JL et al (2012) Towards universal health coverage: an evaluation of rwanda Mutuelles in its first eight years. Plos One 7:e39282CrossRefPubMedPubMedCentral
go back to reference Mills A, Ataguba JE, Akazili J et al (2012) Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage. Lancet 380:126–133CrossRefPubMed Mills A, Ataguba JE, Akazili J et al (2012) Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage. Lancet 380:126–133CrossRefPubMed
go back to reference Ministry of Health of Rwanda (2010) Rwanda national health insurance policy. Ministry of Health of Rwanda, Kigali Ministry of Health of Rwanda (2010) Rwanda national health insurance policy. Ministry of Health of Rwanda, Kigali
go back to reference National Institute of Statistics of Rwanda (2013) Rwanda statistical year book 2012. National Institute of Statistics of Rwanda, Kigali National Institute of Statistics of Rwanda (2013) Rwanda statistical year book 2012. National Institute of Statistics of Rwanda, Kigali
go back to reference Parmar D, De Allegri M, Savadogo G, Sauerborn R (2014) Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso. Health Policy Plan 29:76–84CrossRefPubMed Parmar D, De Allegri M, Savadogo G, Sauerborn R (2014) Do community-based health insurance schemes fulfil the promise of equity? A study from Burkina Faso. Health Policy Plan 29:76–84CrossRefPubMed
go back to reference Sekabaraga C, Diop F, Soucat A (2011) Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda. Health Policy Plann 26:Ii52–Ii62CrossRef Sekabaraga C, Diop F, Soucat A (2011) Can innovative health financing policies increase access to MDG-related services? Evidence from Rwanda. Health Policy Plann 26:Ii52–Ii62CrossRef
go back to reference Wagstaff A, van Doorslaer E (2000) Measuring and testing for inequity in the delivery of health care. J Hum Resour 35:716–733CrossRef Wagstaff A, van Doorslaer E (2000) Measuring and testing for inequity in the delivery of health care. J Hum Resour 35:716–733CrossRef
go back to reference World Health Organization (2009) Health financing systems review of Rwanda: options for universal coverage. World Health Organization, Geneva World Health Organization (2009) Health financing systems review of Rwanda: options for universal coverage. World Health Organization, Geneva
go back to reference World Health Organization (2017) Health Equity Assessment Toolkit (HEAT): software for exploring and comparing health inequalities in countries. Built-in database edition. Version 1.1. World Health Organization, Geneva World Health Organization (2017) Health Equity Assessment Toolkit (HEAT): software for exploring and comparing health inequalities in countries. Built-in database edition. Version 1.1. World Health Organization, Geneva
Metadata
Title
Health inequality and community-based health insurance: a case study of rural Rwanda with repeated cross-sectional data
Authors
Kai Liu
Benjamin Cook
Chunling Lu
Publication date
01-01-2019
Publisher
Springer International Publishing
Published in
International Journal of Public Health / Issue 1/2019
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI
https://doi.org/10.1007/s00038-018-1115-5

Other articles of this Issue 1/2019

International Journal of Public Health 1/2019 Go to the issue