With progress towards universal health coverage (UHC) the disease burden of non-communicable diseases (NCDs) in LMICs is increasing while inequalities in healthcare access exist. We aimed to investigate whether health insurance enables people with NCDs to utilize health services more than their counterparts without insurance.
Using a quantitative research method and data from the Zambia Household Health Expenditure Utilization Survey (ZHHEUS, 2013) conducted in 2013, we focussed on the people who recalled visiting a health facility a month prior to the survey, 8,146 of whom said yes. Approximately 2247 had an NCD while 229 were covered by health insurance. Only women age 15-49 and men age 15-59 who were interviewed for information regarding themselves and other members of the household. The survey included questions on demographics, health status (self-rated health); illness experiences, healthcare utilization (visits, admission, type of providers sought, health expenditure); and insurance cover. Specifically, individuals were asked if they had visited a health facility in the 4 weeks preceding the survey.
We find that NCDs are associated with an increase in healthcare use (5.4 percentage points (pp); 95% CI -0.28 to 0.09; p=<0.001). Utilization increases further for those with NCDs by having health insurance (6.4pp; 95% CI -0.18 to 0.05; p=0.285) though the association was not statistically significant. Having health insurance itself, regardless of NCD status, is associated with a higher utilization (6.4pp; 95% CI -0.13 to 0.0005; p=0.048).
Our results suggest that health insurance may play an important role in improving access among people with chronic conditions, and since they mainly affect poorer households, health insurance may have a strong equity result in a low- and middle-income country context.