Journal of health, population, and nutrition · 2026
Equity in health insurance coverage among women with children under two years of age in Laos: a cross-sectional study of sociodemographic disparities and implications for universal health coverage.
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Bunde Elizabeth, Oyediran Kola A, Xayalath Bouangern, Posner Jessica, Davis Nicole, Inthavong Souksakhone, Komphasouk Banthida
Аннотация
BACKGROUND: Achieving universal health coverage (UHC) in Laos requires a financing system that supports equitable access to essential services, especially for underserved groups. The National Health Insurance (NHI) scheme, integrating prior social and community-based programs, provides coverage for essential services and reduces out-of-pocket costs. Understanding socioeconomic factors shaping enrollment is critical to avoid policies that unintentionally reinforce inequities.
METHODS: We conducted a secondary analysis of cross-sectional survey data from 2,138 women with children aged 0-23 months across five Laos provinces. Multivariable logistic regression models estimated associations between sociodemographic factors and health insurance coverage, including an interaction term to examine provincial variations in the effect of education.
RESULTS: One-third of women had health insurance. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) were estimated using multivariable logistic regression. Coverage was higher among older women, those with secondary education or above (aOR = 2.00, 95% CI: 1.57-2.54), employed women (aOR = 1.71, 95% CI: 1.30-2.24), women exposed to health messages (aOR = 2.03, 95% CI: 1.62-2.54), and those from wealthier households (highest vs. lowest quintile: aOR = 1.91, 95% CI: 1.23-2.91). Rural residence (aOR = 0.65, 95% CI: 0.48-0.87) and larger households (7-8 members: aOR = 0.68, 95% CI: 0.37-0.91) were associated with lower coverage. Provincial variation in maternal education showed Savannakhet and Oudomxay had relatively high coverage even among less educated women, whereas Phongsaly, Salavan, and Sekong displayed marked socioeconomic disparities.
CONCLUSIONS: Health insurance enrollment is driven by a multidimensional set of factors, including education, household wealth, and geographic location. While provincial disparities and education are critical determinants, they interact with broader socioeconomic constraints. Achieving UHC coverage requires holistic interventions that not only target specific disadvantaged regions but also address the underlying social and financial barriers impeding access for vulnerable women.
METHODS: We conducted a secondary analysis of cross-sectional survey data from 2,138 women with children aged 0-23 months across five Laos provinces. Multivariable logistic regression models estimated associations between sociodemographic factors and health insurance coverage, including an interaction term to examine provincial variations in the effect of education.
RESULTS: One-third of women had health insurance. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) were estimated using multivariable logistic regression. Coverage was higher among older women, those with secondary education or above (aOR = 2.00, 95% CI: 1.57-2.54), employed women (aOR = 1.71, 95% CI: 1.30-2.24), women exposed to health messages (aOR = 2.03, 95% CI: 1.62-2.54), and those from wealthier households (highest vs. lowest quintile: aOR = 1.91, 95% CI: 1.23-2.91). Rural residence (aOR = 0.65, 95% CI: 0.48-0.87) and larger households (7-8 members: aOR = 0.68, 95% CI: 0.37-0.91) were associated with lower coverage. Provincial variation in maternal education showed Savannakhet and Oudomxay had relatively high coverage even among less educated women, whereas Phongsaly, Salavan, and Sekong displayed marked socioeconomic disparities.
CONCLUSIONS: Health insurance enrollment is driven by a multidimensional set of factors, including education, household wealth, and geographic location. While provincial disparities and education are critical determinants, they interact with broader socioeconomic constraints. Achieving UHC coverage requires holistic interventions that not only target specific disadvantaged regions but also address the underlying social and financial barriers impeding access for vulnerable women.