Can Health Insurance Coverage Improve Quality of Reproductive and Maternity Care in Low- and Middle-Income Countries? A Multi-Country Propensity Score Matching Study
Journal
World Congress on Health Economics
Date Issued
2023-07-10
Author(s)
Tiara Marthias
Kanya Anindya
Sukumar Vellakkal
Nawi Ng
Thomas Hone
Dennis La
Yang Zhao
Huan Wang
Reza Pandu Aji
Barbara McPake
Abstract
Background
Poor maternal and child health afflicts millions of women and children, particularly in low-and middle-income countries (LMICs). This study assessed the impact of social health insurance programs on the continuum of care for reproductive and maternal health in nine LMICs.
Methods
We used the latest two waves of the Demographic and Health Survey (DHS) collected between 2012–2017 from nine LMICs with different social health insurance scheme and coverage (Cambodia, Dominican Republic, Ghana, Guatemala, India, Indonesia, Jordan, Kyrgyz Republic, and Peru), constituting around 25% of the global population. Using the effective coverage care cascade that is defined as the proportion of individuals experiencing health gains from a service among those who need the service, we estimated the association between health insurance and quality of care for family planning, antenatal care (ANC), maternal delivery service, and postnatal care (PNC). We estimated the difference-in-difference models combined with coarsened exact matching method (may replace with PSM if you still prefer) to address the selection bias arising from the voluntary nature of insurance program participation and reported the average treatment effect on the treated (ATT).
Findings
In seven out of nine LMICs investigated, health insurance coverage was linked to significant improvements in most of the reproductive and maternity care quality metrics, even among those with already high coverage levels. For example, social health insurance coverage was associated with significant improvement in family planning (ATT for service contact=8.2 percentage points [pp, 95% CI=4.7, 11.7], crude coverage=5.1 pp [95% CI=2.3, 8.0], quality-adjusted coverage= 2.8 pp [95% CI=0.9, 4.6]); antenatal care (ATT for service contact=2.3 pp [95% CI=1.0, 3.5], crude coverage=4.9 pp [95% CI=2.7, 7.1], quality-adjusted coverage=6.5 pp [95% CI=4.1, 9.0] and user-adherence-adjusted coverage=4.6 pp [95% CI=1.8 ,7.3]); delivery care (ATT for service contact=3.0 pp [95% CI=1.4, 4.6], crude coverage=3.6 pp [95% CI=1.8, 5.4]) and postnatal care (ATT for service contact=2.1 pp [95% CI 0.9, 3.2], and quality-adjusted coverage=1.8 pp [95% CI=0.3, 4.0]). The magnitude of the effects, however, varied significantly across metrics and countries.
Interpretation
Using the most recent wave of a nationally representative survey of nine LMICs, our findings show that health insurance coverage is associated with significant improvements in the quality of care for maternal health services. These findings provide important evidence in support of accelerating the coverage of universal health insurance (including both public and private health insurance) in order to close the inequality gaps in maternal and child burdens in LMICs.
Publisher
International Health Economics Association
Type
conference presentation