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.
