ArticleGlobal health action2026
Health insurance and the distribution of healthcare use in Rwanda's Vision Umurenge Programme: evidence from the Seventh Integrated Household Living Conditions Survey.
Article in Global health action, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
backgroundRwanda's community-based health insurance (CBHI) has achieved near-universal enrollment, yet inequities in healthcare use remain. Understanding whether coverage translates into equitable utilization is critical for advancing universal health coverage (UHC). This study aims to examine how social protection complements health insurance in promoting equitable healthcare access.
objectiveTo examine the relationship between insurance coverage and healthcare utilization in sectors targeted by the Vision Umurenge Programme (VUP), assess socioeconomic inequities, and evaluate the complementary role of social protection.
methodsThis study analyzed cross-sectional data from 15,039 households in VUP sectors using the 2023-2024 Seventh Integrated Household Living Conditions Survey. Socioeconomic inequality was measured using Erreygers-corrected concentration indices and need-standardized horizontal inequity analysis. Insurance effects were estimated using survey weighted logistic regression, propensity score matching, and doubly robust inverse-probability-weighted regression adjustment.
resultsInsurance coverage was 85.8%, yet only 25.5% reported any formal healthcare utilization in the 12 months preceding the survey, including outpatient visits, inpatient admissions and preventive services. Utilization showed stronger pro-rich concentration (E = +0.066) than coverage (E = +0.026) and need-standardized analysis confirmed residual inequity. Insurance increased utilization by +14.6% points in regression models and ~+12% points in causal estimators. Participation in VUP components, particularly direct support, was consistently associated with higher service use.
conclusionsIn a high coverage setting, persistent pro-rich inequities highlight the role of non-financial barriers such as indirect costs and service readiness. Layering social protection with insurance and strengthening primary care delivery is critical to convert nominal coverage into equitable healthcare access.
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