Wang, Wenjuan, Gheda Temsah, and Lindsay Mallick. 2014. Health Insurance Coverage and Its Impact on Maternal Health Care Utilization in Low- and Middle-Income Countries. DHS Analytical Studies No. 45. Rockville, Maryland, USA: ICF International.
This study examined levels of health insurance coverage in 30 low- and middle-income countries (LMICs), using nationally representative data from the Demographic and Health Surveys (DHS). In eight countries with health insurance coverage exceeding 10 percent, we used propensity score matching and estimated the impact of health insurance status on the use of antenatal care and facility-based delivery care. Health insurance coverage rates were less than 5 percent in most countries. In a few countries (Rwanda, Gabon, Ghana, and Indonesia), more than one-third of interviewed women and men reported coverage of health insurance, with the highest rate found in Rwanda. Educational attainment was associated with a higher likelihood of enrolling in health insurance. Pro-wealthy disparities in health insurance coverage existed in the majority of countries. In Cambodia and Gabon, however, poor women were more likely than the rich to be covered by health insurance, suggesting that in these countries policies focusing on providing insurance for the poor have been effective.
Our analysis found significant positive effects of health insurance coverage on at least one measure of maternal health care use in seven of the eight countries evaluated. Indonesia stands out for the most systematic effect of health insurance across all measures, followed by Cambodia, Rwanda, and Ghana. The positive impact of health insurance appeared more consistent on the use of facility-based delivery than use of antenatal care. The analysis provides clear evidence that health insurance has contributed to the increased use of maternal health care services.