Kai Liu1, Benjamin Cook2, Chunling Lu3,4,5. 1. Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China. 2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA. 3. Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. chunling_lu@hms.harvard.edu. 4. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. chunling_lu@hms.harvard.edu. 5. Department of Science and Technology-National Research Foundation (DST-NRF) Center of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa. chunling_lu@hms.harvard.edu.
Abstract
OBJECTIVES: To investigate the inequality in medical care utilization and household catastrophic health spending (HCHS) between the poverty and non-poverty residents in rural Rwanda and their links with community-based health insurance (Mutuelles). METHODS: We used the 2005 and 2010 nationally representative Integrated Living Conditions Surveys. We estimated multilevel logistic regression models to obtain the adjusted levels and trends of both absolute and relative inequalities and examined associations between Mutuelles status and these inequalities. RESULTS: Significant inequality between the two income groups, in both absolute and relative measures of medical care utilization and HCHS remained unchanged in 2005 and 2010. Significant reduction in adjusted absolute inequality in percentage of HCHS between the two years was not associated with Mutuelles status. CONCLUSIONS: While Mutuelles promoted medical care utilization and reduced HCHS, it did not play a significant role in reducing their inequalities by poverty status between 2005 and 2010. Future studies should assess the impact of additional strategies (e.g., the exemption of Mutuelles premiums and copayments for households living in poverty), on reducing inequality by poverty status.
OBJECTIVES: To investigate the inequality in medical care utilization and household catastrophic health spending (HCHS) between the poverty and non-poverty residents in rural Rwanda and their links with community-based health insurance (Mutuelles). METHODS: We used the 2005 and 2010 nationally representative Integrated Living Conditions Surveys. We estimated multilevel logistic regression models to obtain the adjusted levels and trends of both absolute and relative inequalities and examined associations between Mutuelles status and these inequalities. RESULTS: Significant inequality between the two income groups, in both absolute and relative measures of medical care utilization and HCHS remained unchanged in 2005 and 2010. Significant reduction in adjusted absolute inequality in percentage of HCHS between the two years was not associated with Mutuelles status. CONCLUSIONS: While Mutuelles promoted medical care utilization and reduced HCHS, it did not play a significant role in reducing their inequalities by poverty status between 2005 and 2010. Future studies should assess the impact of additional strategies (e.g., the exemption of Mutuelles premiums and copayments for households living in poverty), on reducing inequality by poverty status.
Keywords:
Absolute inequality; Catastrophic health spending; Health inequality; Medical care utilization; Relative inequality; Rwanda