Abstract
BackgroundEnsuring 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.MethodsUsing 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.ResultsAt 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.ConclusionsPoverty 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.
Highlights
Ensuring equitable access to medical care with financial risk protection has been at the center of achieving universal health coverage
Testing the statistical significance of the levels and trends of the inequalities To test whether inequalities in medical care utilization or household catastrophic health spending (HCHS) significantly existed in the four survey years, we examined whether the 95% confidence intervals (CIs) of the absolute estimates crossed the value of zero and whether the relative estimates crossed the value of one
The absolute inequality in medical care utilization decreased by 27%, and in HCHS it decreased by 39%
Summary
Ensuring equitable access to medical care with financial risk protection has been at the center of achieving universal health coverage. 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. Ensuring access to care and providing financial risk protection have been the goals of government policies or programs in many developing countries (e.g. China, Ghana, Mali, and Mexico, Rwanda, and Vietnam) [3,4,5,6,7,8,9]. A core essence of health equity lies in mitigating systematic disparities in medical care utilization and household catastrophic health spending (HCHS) in different social groups [10,11,12]. Though Rwanda has been making remarkable progress in both social and economic development, as evidenced by its increasing GDP per capita from US$349 (constant 2010 US$) in 2001 to US$690 in 2015 [13], it remains one of the most undeveloped countries in the world, with 39.1% of its citizens living below the national poverty line in 2014 [14]
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