Impact of Health Insurance on Mortality in Zimbabwean Households, Does Gender Heterogeneity Matter?
Résumé
Abstract Globally, impact of health insurance on mortality remains inconclusive, yet health insurance is considered a progressive health financing mechanism. Zimbabwe is grappling with the duet of health financing and suboptimal health outcomes. The purpose of this study was to interrogate the impact of health insurance and gender heterogeneity on mortality, with a view to proffer context specific credible policy recommendations. Specifically, the study sought to evaluate the impact of health insurance on mortality in a household and to establish gender heterogeneity effect on mortality in a household. This study utilised existing nationally representative, cross sectional secondary data from the Zimbabwe Demographic and Health Survey (2015), constituting a sample of 9631, comprising of 3498 and 6130 male headed and female headed households respectively. Data was analysed using STATA version 15, utilising both probit and logistic Regression models for corroboration of analyses results. Marginal effects were also computed in this study. Chi squared test results show no association between health insurance and mortality in a household, Pearson Chi2 = 0.05 Prob = 0.8169. On the contrary, results show association between gender and mortality in a household, Pearson Chi2 = 5.05 Prob = 0.0247. Triangulated empirics from both logistic and probit regression analysis show that having health insurance in a household has no statistically significant effect on mortality in a household, (OR=0.988; 95% CI: 0.157-0.175). Conversely, gender was found to have statistically significant effect on mortality in a household at 5% level of significance (OR=1.133; 95% CI= 1.008-1.273). Female headed households have a 13.3% higher chance of experiencing death, by comparison to their male headed households’ counterparts. Upon marginal effects analysis, evidence show that the likelihoodness of experiencing mortality in a male headed household was 15% (95% CI: 0.138-0.162) whereas chances of experiencing mortality in a female headed household increases to 16, 6% (95% CI: 0.157-0.175). This confirms the significance of gender heterogeneity on mortality in a household reported by the regression results. Indicating that female headed households have a 1.6% higher chance of experiencing death, by comparison to male headed households. Further, evidence from marginal effects analysis show that if the household has health insurance, chances of experiencing death is 15.9% (95% CI: 0.138-0.179), comparably if a household has no health insurance, chances of experiencing death is 16% (95% CI: 0.152-0.168). There is limited difference between the effects of health insurance on household mortality, as indicated by a 0.01% difference in chances of experiencing mortality in a household confirming the above regression results. This study concluded that health insurance has no impact on mortality in a household, conversely gender heterogeneity affects the occurrence of mortality in a household. This study thus recommends health insurance reforms, including addressing challenges of short falls and copayments faced by the insured. Preferential gender sensitive social interventions, targeting females and female headed households should be considered.
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