The effect of wealth status on health insurance status among women of reproductive age group in Ethiopia: evidence from Ethiopian demographic and health survey data 2016.

Abstract

Abstract Introduction: Out of pocket expenditure has prohibit poor women from medical consultation. Evidence showed that even though health insurance had brought significant change on maternal health outcomes, health insurance status/ coverage favored to men. Nevertheless there is limited evidence on health insurance coverage and its predictors among women of reproductive age group in Ethiopia. Objective: The objective of this study is to determine the effect of wealth status on health insurance status among women aged 15-49 years in Ethiopia using Ethiopian demographic and health survey data 2016. Methods: The data were obtained from national representative Ethiopian Demographic and Health Survey (EDHS) data 2016. A total of 15,683 women age 15-49 years were included in the analysis.Two separate models were used to analyze the data. Logit model was used to identify predictors and to calculate p-score using stata version 14. Propensity score analysis was used to determine wealth status effect on health insurance status.Since this method is used to balance the treated (those who belonged to the rich households) and control (those who belonged to the poor households) units so that a direct comparison would be possible for evaluating the effects. Results: Only 4.2% (95% CI (3.9 – 4.5)) of women age 15-49 years were insured. Logistic regression result showed that women residing to female headed household were 20% times less likely to be insured (AOR = 0.80; 95% CI (0.642, 0.999)) compared to those women from male-headed households. Women who lived in Amhara region were 2.9 times more likely to be insured compared with women residing in Addis Ababa (AOR=2.9; 95%CI: 2.1, 4.3). Women who were employed as an Agricultural employee were1.9 times more likely to be insured compared with their counterparts those who did not employed (AOR=1.9, 95%CI: 1.54-2.50). Women who were attending a higher level of education were 2.1 times more likely to be insured compared with their counterparts those who did not enrolled in any formal education (AOR=2.1, 95% CI (1.38, 3.15). Women belonged to rich households were 2.04 times more likely to be insured compared with those belonged to poor households (AOR=2.04; CI=1.55-2.62). The propensity score analysis result also indicated that wealth status increases the percentage (level of) of women’s health insurance status on average by about 3.9% (beta=0.039; 95%CI (0.027-0.049) among women who Belonged to households with middle wealth status compared to their matched counter parts’ (women who belonged to poor wealth status households). Conclusion and recommendation: Women’s level of health insurance was very low. Level of education, sex of household head, Region, exposure to media, wealth status and their occupation have affected women’s health insurance status/coverage. Therefore this study recommends: Besides expanding Community based health insurance and starting social health insurance for urban dwellers/formal workers, enhancing women education, strengthening media, and improving women’s employment should be given due attention. Key words: Socio-demographic predictors, wealth status, health insurance status, women, Ethiopia, EDHS 2016.