Assessing national and subnational inequalities in medical care utilization and financial risk protection in Rwanda

Abstract Background Ensuring equitable access to medical care with financial risk protection has been at the center of achieving universal health coverage. In this paper, we assess the levels and trends of inequalities in medical care utilization and household catastrophic health spending (HCHS) at...

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Main Authors: Kai Liu, S. V. Subramanian, Chunling Lu
Format: Article
Language:English
Published: BMC 2019-03-01
Series:International Journal for Equity in Health
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12939-019-0953-y
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author Kai Liu
S. V. Subramanian
Chunling Lu
author_facet Kai Liu
S. V. Subramanian
Chunling Lu
author_sort Kai Liu
collection DOAJ
description Abstract Background Ensuring equitable access to medical care with financial risk protection has been at the center of achieving universal health coverage. In this paper, we assess the levels and trends of inequalities in medical care utilization and household catastrophic health spending (HCHS) at the national and sub-national levels in Rwanda. Methods Using the Rwanda Integrated Living Conditions Surveys of 2005, 2010, 2014, and 2016, we applied multivariable logit models to generate the levels and trends of adjusted inequalities in medical care utilization and HCHS across the four survey years by four socio-demographic dimensions: poverty, gender, education, and residence. We measured the national- and district-level inequalities in both absolute and relative terms. Results At the national level, after controlling for other factors, we found significant inequalities in medical care utilization by poverty and education and -in HCHS by poverty in all four years. From 2005 to 2016, inequalities in medical care utilization by the four dimensions did not change significantly, while the inequality in HCHS by poverty was reduced significantly. At the district level, inequalities in both medical care utilization and HCHS were larger than zero in all four years and decreased over time. Conclusions Poverty and poor education were significant contributors to inequalities in medical care utilization and HCHS in Rwanda. Policies or interventions targeting poor households or households headed by persons receiving no education are needed in order to effectively reduce inequalities in medical care utilization and HCHS.
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spelling doaj.art-8b89387ce8a147b18aec18da77ca18da2022-12-21T19:55:43ZengBMCInternational Journal for Equity in Health1475-92762019-03-0118111010.1186/s12939-019-0953-yAssessing national and subnational inequalities in medical care utilization and financial risk protection in RwandaKai Liu0S. V. Subramanian1Chunling Lu2Department of Social Security, School of Labor and Human Resources, Renmin University of ChinaDepartment of Social and Behavioral Sciences, Harvard T.H. Chan School of Public HealthDivision of Global Health Equity, Brigham & Women’s HospitalAbstract Background Ensuring equitable access to medical care with financial risk protection has been at the center of achieving universal health coverage. In this paper, we assess the levels and trends of inequalities in medical care utilization and household catastrophic health spending (HCHS) at the national and sub-national levels in Rwanda. Methods Using the Rwanda Integrated Living Conditions Surveys of 2005, 2010, 2014, and 2016, we applied multivariable logit models to generate the levels and trends of adjusted inequalities in medical care utilization and HCHS across the four survey years by four socio-demographic dimensions: poverty, gender, education, and residence. We measured the national- and district-level inequalities in both absolute and relative terms. Results At the national level, after controlling for other factors, we found significant inequalities in medical care utilization by poverty and education and -in HCHS by poverty in all four years. From 2005 to 2016, inequalities in medical care utilization by the four dimensions did not change significantly, while the inequality in HCHS by poverty was reduced significantly. At the district level, inequalities in both medical care utilization and HCHS were larger than zero in all four years and decreased over time. Conclusions Poverty and poor education were significant contributors to inequalities in medical care utilization and HCHS in Rwanda. Policies or interventions targeting poor households or households headed by persons receiving no education are needed in order to effectively reduce inequalities in medical care utilization and HCHS.http://link.springer.com/article/10.1186/s12939-019-0953-yHealth inequalityMedical care utilizationHousehold catastrophic health spendingAbsolute inequalityRelative inequalityRwanda
spellingShingle Kai Liu
S. V. Subramanian
Chunling Lu
Assessing national and subnational inequalities in medical care utilization and financial risk protection in Rwanda
International Journal for Equity in Health
Health inequality
Medical care utilization
Household catastrophic health spending
Absolute inequality
Relative inequality
Rwanda
title Assessing national and subnational inequalities in medical care utilization and financial risk protection in Rwanda
title_full Assessing national and subnational inequalities in medical care utilization and financial risk protection in Rwanda
title_fullStr Assessing national and subnational inequalities in medical care utilization and financial risk protection in Rwanda
title_full_unstemmed Assessing national and subnational inequalities in medical care utilization and financial risk protection in Rwanda
title_short Assessing national and subnational inequalities in medical care utilization and financial risk protection in Rwanda
title_sort assessing national and subnational inequalities in medical care utilization and financial risk protection in rwanda
topic Health inequality
Medical care utilization
Household catastrophic health spending
Absolute inequality
Relative inequality
Rwanda
url http://link.springer.com/article/10.1186/s12939-019-0953-y
work_keys_str_mv AT kailiu assessingnationalandsubnationalinequalitiesinmedicalcareutilizationandfinancialriskprotectioninrwanda
AT svsubramanian assessingnationalandsubnationalinequalitiesinmedicalcareutilizationandfinancialriskprotectioninrwanda
AT chunlinglu assessingnationalandsubnationalinequalitiesinmedicalcareutilizationandfinancialriskprotectioninrwanda