ReviewThe Lancet. Global health2024
The path to universal health coverage in five African and Asian countries: examining the association between insurance status and health-care use.
Review in The Lancet. Global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 6 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Disparities in modern health service utilization between community-based health insurance member and non-member households in Ethiopia: a meta-analysis.BMC public health · 2026Pooled it
- High Burden and Trend in Nonadherence to Blood Pressure-Lowering Medications: Meta-Analysis of Data From Over 34 000 Adults With Hypertension in Sub-Saharan Africa.Journal of the American Heart Association · 2025Pooled it
- A scoping review of school-based oral health interventions among adolescents in Nigeria.Frontiers in oral health · 2025Pooled it
- Access to health insurance amongst people with disabilities and its association with healthcare use, health status and financial protection in low- and middle-income countries: a systematic review.International journal for equity in health · 2024Pooled it
- The prevalence of Hemophilia A in males in Africa: evidence from a systematic review and meta-analysis.BMC public health · 2024Pooled it
- Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis.Frontiers in public health · 2024Pooled it
- Acceptability of ambulatory surgery provided in freestanding ambulatory surgical centers and its associated factors among surgical healthcare providers in Uganda.Surgical endoscopy · 2026Article
- Heterogeneity of patient preferences for long-acting HIV treatment among people with HIV in Kenya.BMC infectious diseases · 2026Article
- The effect of community-based health insurance on out-of-pocket expenditure among diabetic patients at hawassa university comprehensive specialized hospital: facility-based comparative cross-sectional study.BMC health services research · 2026Article
- Drivers of community-based health insurance enrolment in post-war Tigray, Ethiopia.BMJ global health · 2026Article
- Research gaps on universal health coverage in the South African context and other low and middle-income countries; putting things into perspective: a scoping review.BMC health services research · 2026Article
- Factors associated with breast cancer screening among insured and uninsured women in Tanzania: an analysis of the Tanzania demographic and health survey 2022.Health economics review · 2026Article
- Economic burden of malaria in the Brazilian Amazon from a societal perspective.PLOS global public health · 2026Article
- Health insurance in Nigeria: Findings from the People's Voice Survey.PLOS global public health · 2026Article
- Access to digital health technologies: personalized framework and global perspectives.Nature reviews. Cardiology · 2026Review
- Examining the potential of mobile money-based health insurance for people living with HIV and hypertension or diabetes in Uganda.Frontiers in health services · 2026Article
- Trends in mortality, pathogen distribution, and antimicrobial resistance of peritoneal and intra-abdominal infections from 1990 to 2021: a cross-sectional analysis of the MICROBE database.International journal of surgery (London, England) · 2025Article
- Household attitudes and associated factors toward community-based health insurance in the Awi Zone, Ethiopia: a community-based cross-sectional study design.BMC health services research · 2025Article
- Benchmarking progress in non-communicable diseases: a global analysis of cause-specific mortality from 2001 to 2019.Lancet (London, England) · 2025Article
- Prostate cancer in low- and middle-income countries - challenges and opportunities.Prostate cancer and prostatic diseases · 2025Review
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Authors and funding
14 authors at 7 institutions in 7 countries.
Funding
Abstract
Despite major efforts to achieve universal health coverage (UHC), progress has lagged in many African and Asian countries. A key strategy pursued by many countries is the use of health insurance to increase access and affordability. However, evidence on insurance coverage and on the association between insurance and UHC is mixed. We analysed nationally representative cross-sectional data collected between 2022 and 2023 in Ethiopia, Kenya, South Africa, India, and Laos. We described public and private insurance coverage by sociodemographic factors and used logistic regression to examine the associations between insurance status and seven health-care use outcomes. Health insurance coverage ranged from 25% in India to 100% in Laos. The share of private insurance ranged from 1% in Ethiopia to 13% in South Africa. Relative to the population with private insurance, the uninsured population had reduced odds of health-care use (adjusted odds ratio 0·68, 95% CI 0·50-0·94), cardiovascular examinations (0·63, 0·47-0·85), eye and dental examinations (0·54, 0·42-0·70), and ability to get or afford care (0·64, 0·48-0·86); private insurance was not associated with unmet need, mental health care, and cancer screening. Relative to private insurance, public insurance was associated with reduced odds of health-care use (0·60, 0·43-0·82), mental health care (0·50, 0·31-0·80), cardiovascular examinations (0·62, 0·46-0·84), and eye and dental examinations (0·50, 0·38-0·65). Results were highly heterogeneous across countries. Public health insurance appears to be only weakly associated with access to health services in the countries studied. Further research is needed to improve understanding of these associations and to identify the most effective financing strategies to achieve UHC.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.