Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia

Doris Osei Afriyie; Felix Masiye; Fabrizio Tediosi; Günther Fink

doi:10.1016/j.socscimed.2023.115750

Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia

Soc Sci Med. 2023 Mar:321:115750. doi: 10.1016/j.socscimed.2023.115750. Epub 2023 Feb 4.

Authors

Doris Osei Afriyie¹, Felix Masiye², Fabrizio Tediosi³, Günther Fink⁴

Affiliations

¹ Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland. Electronic address: doris.oseiafriyie@swisstph.ch.
² University of Zambia, Department of Economics, Lusaka, Zambia. Electronic address: fmasiye@yahoo.com.
³ Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland. Electronic address: fabrizio.tediosi@swisstph.ch.
⁴ Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Allschwil, Switzerland; University of Basel, Basel, Switzerland. Electronic address: guenther.fink@swisstph.ch.

PMID: 36801748
DOI: 10.1016/j.socscimed.2023.115750

Abstract

Background: To improve equitable access to quality essential services and reduce financial hardship, low-and-middle-income countries are increasingly relying on prepayment strategies such as health insurance schemes. Among the informal sector population, confidence in the health system to provide effective treatment and trust in institutions can play an important role in health insurance enrollment. The objective of this study was to examine the extent to which confidence and trust affect enrollment into the recently introduced Zambia National Health insurance.

Methods: We conducted a regionally representative cross-sectional household survey in Lusaka, Zambia collecting information on demographics, health expenditure, ratings of last health facility visit, health insurance status and confidence in the health system. We used multivariable logistic regression to assess the association between enrollment and confidence in the private and public health sector as well as trust in the government in general.

Results: Of the 620 respondents interviewed, 70% were enrolled or planning to enroll in the health insurance. Only about one-fifth of respondents were very confident that they would receive effective care in the public health sector 'if they became sick tomorrow' while 48% were very confident in the private health sector. While confidence in the public system was only weakly associated with enrollment, confidence in the private health sector was strongly associated with enrollment (Adjusted odds ratio (AOR) 3.40 95% CI 1.73 - 6.68). No association was found between enrollment and trust in government or perceived government performance.

Conclusions: Our results suggest that confidence in the health system, particularly in the private health sector, is strongly associated with health insurance enrollment. Focusing on achieving high quality of care across all levels of the health system may be an effective strategy to increase enrollment in health insurance.

Keywords: Health insurance; Health systems; Informal sector; Private sector; Public sector; Quality; Trust; Zambia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Humans
Informal Sector*
Insurance, Health*
Medical Assistance
Zambia