Barriers to health insurance uptake in Rwanda: a nationwide cross-sectional survey

achieving universal health coverage by 2030 is a key objective for Rwanda, ensuring equitable access to health insurance. However, approximately 10% of the population remains uninsured. This study aims to identify socio-economic and demographic factors associated with health insurance uptake in Rwanda.

we analyzed secondary data from the Fifth Integrated Household Living Conditions Survey (EICV 5), comprising 14,580 households. Multivariable logistic regression was performed to assess factors associated with health insurance uptake. Descriptive statistics were used to summarize the characteristics of the surveyed households.

the study population had a mean household size of 4.8 individuals, with 62% residing in rural areas. Among household heads, 56% were male, 44% were female, 38% had no formal education, and 64% were employed. Multivariable logistic regression analysis revealed that household heads in the highest wealth quantile had higher odds of being insured (aOR: 3.82, 95% CI: 3.37-4.33; p < 0.001) compared to those in the lowest quintile. Those with no formal education had lower odds of being insured (aOR: 0.57, 95% CI: 0.46-0.71; p < 0.001) than those with higher education. Residents of Kigali City had greater odds of being insured (aOR: 1.52, 95% CI: 1.31-1.75; p < 0.001) compared to residents in other regions. Females were more likely to be insured than males (aOR: 1.21, 95% CI: 1.11-1.34; p < 0.001), while single household heads had lower odds of insurance uptake (aOR: 0.61, 95% CI: 0.60-0.74; p < 0.001) compared to married counterparts. Younger individuals were less likely to be insured (aOR: 0.32, 95% CI: 0.29-0.49; p < 0.001) compared to older adults.

health insurance uptake in Rwanda is significantly influenced by socio-economic and demographic factors, including wealth status, education level, geographic location, gender, marital status, and age. Targeted interventions should prioritize vulnerable groups, such as low-income and less-educated individuals, young adults, and rural residents, to improve insurance coverage.