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Decomposing health inequality with population-based surveys: a case study in Rwanda
Kai Liu1, Chunling Lu2,3,4
1Department of Social Security, School of Labor and Human Resources, Renmin University of China, Haidian District, Beijing, China.
International Journal for Equity in Health
|May 12, 2018
Summary
Poverty significantly drives inequalities in healthcare access and spending in Rwanda. Expanding insurance and reducing travel times are key to achieving equitable care for all.
Area of Science:
- Global Health
- Health Economics
- Health Equity
Background:
- Persistent inequalities in medical care utilization and household catastrophic health spending (HCHS) exist between impoverished and non-impoverished populations in Rwanda.
- Despite progress in health outcomes, understanding the drivers of these disparities is crucial for policy development.
- Decomposing these inequalities is essential for designing effective interventions to promote health equity.
Purpose of the Study:
- To decompose inequalities in medical care utilization among those reporting illnesses.
- To analyze inequalities in household catastrophic health spending (HCHS).
- To differentiate contributions between poverty and non-poverty groups in Rwanda.
Main Methods:
- Utilized nationally representative Integrated Living Conditions Surveys from 2005 and 2010.
- Employed multivariate logistic regression to assess poverty's contribution to inequalities, controlling for covariates.
- Applied a multivariate nonlinear decomposition method to partition inequality sources into compositional and response effects.
Main Results:
- Poverty status was the primary driver of inequalities in medical care utilization and HCHS in both 2005 and 2010.
- Health insurance status and travel time to health centers significantly contributed to inequalities in medical care utilization.
- Health insurance, presence of under-five children, and disabled family members were significant contributors to HCHS inequalities.
- The primary sources of these inequalities remained consistent between 2005 and 2010.
Conclusions:
- Expanding health insurance coverage is a critical policy to mitigate healthcare access and spending inequalities.
- Reducing travel time to health facilities for impoverished populations can help reduce disparities.
- Targeted interventions addressing poverty-related barriers are essential for achieving equitable healthcare in Rwanda.
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