Inequalities in healthcare utilisation: a decomposition analysis based on financial protection against health risks in Senegal

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Abstract Background: Developing countries are characterised by lack of financial protection against health hazards that can lead to health inequity. Improving horizontal equity in the utilisation of health care requires a better understanding of the factors that influence it. This study used Senegal as a case to examine healthcare utilisation disparities and their determinants. Methods: The study used the most recent Demographic and Health Survey (2017) from Senegal. Frequencies, a logit model and an extension of Blinder-Oaxaca decomposition (proposed by Fairlie) were employed to examine healthcare utilisation gap between covered and uncovered people as well as factors explaining this gap.Results: The results of the logistic regression show that healthcare utilisation increases with quintiles of economic well-being; people covered by an insurance or fee exemption scheme use more health care services than those not covered. Women, urban people, children aged under five years and elderly (60 and +). Results from Blinder-Oaxaca decomposition suggests a difference in healthcare utilisation between covered and uncovered people. 39% of these disparities are explained by the distribution of observed characteristics (age, area of residence, economic well-being, education) while 61% of these disparities are explained by differences in coefficients. This component may be related to discriminatory practices in favour of the persons covered.Conclusion: The results also raise the issue of the fragmentation of coverage schemes that can lead to differences in the care packages offered. Public authorities need to make efforts to reduce social inequalities and have an important stewardship role across all branches of society to ensure that policies and actions in other sectors improve health equity.

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