ArticleThe Lancet regional health. Southeast Asia2025
Health insurance coverage among men and women in six countries within the Southeast Asia Region (2015-2022): a multilevel analysis of Demographic
Article in The Lancet regional health. Southeast Asia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Optimizing the invisible costs of anti-VEGF: The road to regularity.Indian journal of ophthalmology · 2026Review
- Abdominal obesity in India: sex stratified multilevel estimates across 707 districts from a nationally representative cross-sectional survey.Scientific reports · 2026Article
- Sample representativeness and temporal comparability in SEAR study.The Lancet regional health. Southeast Asia · 2025Article
- Urgent need to integrate gender-sensitive financing in Southeast Asia's health insurance expansion.The Lancet regional health. Southeast Asia · 2025Article
- Sample representativeness and temporal comparability in SEAR study, and achieving equitable health insurance coverage - Authors' reply.The Lancet regional health. Southeast Asia · 2025Article
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Abstract
Background: Equitable access to quality healthcare without financial hardship is key to achieving Universal Health Coverage (UHC), especially in low- and middle-income countries in the WHO Southeast Asia Region (SEAR). Despite health insurance programmes, high out-of-pocket expenditures remain a barrier. This study evaluates health insurance coverage in SEAR, analysing socioeconomic and demographic factors. Methods: This cross-sectional study used data from Demographic and Health Surveys (2015-2022) conducted in countries within the SEAR (data from six countries for women and five for men). Our analysis separately examined women and men aged 15-49 years using data from their respective individual Demographic and Health Survey datasets. Pooled estimates of health insurance coverage were calculated with 95% CI. Multilevel logistic regression quantified variations at the country and community-levels and identified factors influencing health insurance uptake. Findings: Health insurance coverage varied across SEAR, with Indonesia reporting highest for women (58.2%; 95% CI: 57.65-58.72) and men (56.6%; 95% CI: 55.31-57.88), while lowest in Bangladesh for women (0.3%; 95% CI: 0.22-0.39) and Myanmar for men (1.4%; 95% CI: 1.04-1.83). Indonesia also had highest social security health insurance (women: 31.0%; 95% CI: 30.49-31.49, men: 27.9%; 95% CI: 26.74-29.03). Private insurance was lowest in Myanmar (women: 0.6%; 95% CI: 0.42-0.72, men: 0.9%; 95% CI: 0.60-1.27) and highest in Indonesia (women: 28.0%; 95% CI: 27.54-28.5, men: 30.0%; 95% CI: 28.81-31.14). Health insurance coverage was higher among individuals with higher education, greater exposure to mass media, rural residence, and older age. Insurance uptake was influenced by contextual factors beyond individual characteristics. India had highest community-attributable variation in health insurance uptake [women (53.1%; 95% CI: 52.56-53.62); men (56.3%; 95% CI: 55.17-57.46)], while lowest in Indonesia among women (17.7%; 95% CI: 16.40-18.99) and Maldives among men (10.8%; 95% CI: 6.71-16.84), after adjusting for demographic and socioeconomic factors. Interpretation: With an ageing population, healthcare demand and costs in SEAR will rise. Context-specific health insurance policies and targeted interventions are crucial for bridging coverage gaps and achieving UHC. Funding: There is no specific funding for this study.
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