A cross-sectional analysis of the impact of health insurance on the use of health care in Rwanda

Although the policy in Rwanda aims at ensuring quality healthcare, a portion of the Rwandan population still does not have access to it due to the lack of health insurance. This study investigates the impact of health insurance on healthcare utilization in all 30 administrative districts of Rwanda, using secondary data from the 5th Integrated Household Living Conditions Survey (EICV 5) in Rwanda, with a total of 14,580 households. A logistic regression model was used to evaluate the effects of health insurance on healthcare utilization, and a decision tree model was adopted to categorize districts based on the use of health services. This study has made a novel contribution to the existing research by classifying districts based on similarities in the use of health care services, regarding households with or without health insurance. The results showed a significant age effect on the use of health care services for household heads with an age range of 56-65, a significant increase was observed with an adjusted odds ratio of AO = 1.308, (95% CI: 1.044-1.639). It was the same for the household heads whose age range is 66-75 with an adjusted odds ratio of A0 = 1.589 with (95% CI: 1.244-2.028) and those aged 76 and older with an adjusted odds ratio of AO = 1.524, with (95% CI: 1.170-1.985). Households with health insurance interacted with districts (A0 = 2.76) increased health service use threefold compared to households without health insurance, female-headed households increased health service use (AO = 1.423, 95% CI:1.293-1.566) 1.4-fold compared to male-headed households, while households in the third quintile (AO = 1.198, 95% CI: 1.035-1.385) used health services 1.2 times compared to those in the first quintile; households in the fourth quintile (AO = 1.307, 95% CI: 1.134-1.506) and in the fifth quintile (AO = 1.307, 95% CI: 1.136 1.504) used health services 1.3 times compared to those in the first quintile. Similarly, for the households located in the main district group 4 variable had an odds ratio of 1.386 with (95% CI: 1.242-1.547), indicating that the households located in the main district group 4 use the health care services 1.4 times higher compared to those located in Ruhango district. Households in Rwanda who lack health insurance do not utilize health services to their full capacity, which has a negative influence on the wellbeing of the country's population. The researchers recommend that future policies target households in rural areas with an elderly head of household and those without health insurance that have a low usage of health care services in Rwanda. They also recommend that health insurance fees are reduced in order to increase health coverage rate as recommended by the World Health Organization.