The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

Kazibwe, Joseph; Tran, Phuong Bich; Kaiser, Andrea Hannah; Kasagga, Simon Peter; Masiye, Felix; Ekman, Björn; Sundewall, Jesper

doi:10.1186/s12913-024-10815-5

Table 4 Magnitude of impact by study

From: The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

Authors	country	Sample size	Measure	Effect size	Lower bound	Upper bound	Standard error	Standard deviation	Significant at 95% CI
At least 4 ANC visits
Ravit et al. 2020 [36]	Mauritania	1496	ATE	0.11	0.06	0.16			Significant
Rashad et al. 2019 [38]	Egypt	9960	ATT	0.041			0.01		Significant
Philibert et al. 2017 [40]	Mauritania	3520	Absolute risk	0	-0.05	0.05			Not Significant
Anindya et al. 2020 [41]	Indonesia	5705	ATT	0.074	0.048	0.099			Significant
Bonfrer et al. 2016 [44]	Ghana	2002	ATT	0.07					Significant
El Omari et al. 2021 [45]	Philippines	3648	ATE	0.085				0.109	Significant
Wang et al. 2017 [46]	Ghana	1753	ATT	0.0771			0.0257		Significant
Wang et al. 2017 [46]	Indonesia	14,318	ATT	0.026			0.006		Significant
Wang et al. 2017 [46]	Rwanda	6016	ATT	0.0195			0.0203		Significant
Mussa et al. 2023 [49]	Ethiopia	1564	ATE	0.004	-0.056	0.063			Not Significant
Number of ANC visits during a pregnancy
Kofinti et al. 2022 [47]	Ghana	4169	ATE	0.432			0.101		Significant
Bousmah et al. 2022 [48]	Senegal (contributory)	804	ATE	0.565			0.18		Significant
Bousmah et al. 2022 [48]	Senegal (non-contributory)	983	ATE	− 0.325			0.36		Not significant
Number of ANC visits in 1st trimester
Aizawa 2019 [43]	Indonesia (non-contributory insurance)	3717	ATE	–0.0823			0.0597		Not significant
Aizawa 2019 [43]	Indonesia (contributory insurance)	3314	ATE	0.0721			0.0717		Not significant
Wang et al. 2017 [46]	Ghana	1753	ATT	0.0184			0.0365		Not significant
Wang et al. 2017 [46]	Indonesia	14,318	ATT	0.017			0.008		Significant
Wang et al. 2017 [46]	Rwanda	6016	ATT	0.017			0.0206		Not significant
ANC with skilled staff
Philibert et al. 2017 [40]	Mauritania	4029	Absolute risk	0.06	0.01	0.11			Significant
Bonfrer et al. 2016 [44]	Ghana	2002	ATT	0.05					Not significant
Mussa et al. 2023 [49]	Ethiopia	1564	ATE	0.017	-0.053	0.087			Not significant
Delivery at health facility
Agbanyo et al. 2021 [35]	Ghana	8818	Marginal effects	0.203			19.56		Significant
Ravit et al. 2020 [36]	Mauritania	2602	ATE (District hospital)	0.04	0	0.08			Significant
Rashad et al. 2019 [38]	Egypt	9960	ATT	0.034			0.01		Significant
Gouda et al. 2016 [39]	Philippines	1376	ATT	0.0973			0.035		Significant
Philibert et al. 2017 [40]	Mauritania		Absolute risk	− 0.04	-0.09	0.13			Not Significant
Anindya et al. 2020 [41]	Indonesia	5705	ATT	0.102	0.075	0.127			Significant
Aizawa 2019 [43]	Indonesia (non contributory insurance)	3720	ATE	0.203			0.0122		Significant
Aizawa 2019 [43]	Indonesia (contributory insurance)	3317	ATE	0.13			0.0125		Significant
Bonfrer et al. 2016 [44]	Ghana	2002	ATT	0.12					Significant
Wang et al. 2017 [46]	Ghana	1837	ATT	0.1058			0.0319		Significant
Wang et al. 2017 [46]	Indonesia	14,954	ATT	0.049			0.009		Significant
Wang et al. 2017 [46]	Rwanda	6122	ATT	0.0745			0.0186		Significant
Kofinti et al. 2022 [47]	Ghana	4169	ATE	0.062			0.017		Significant
Bousmah et al. 2022 [48]	Senegal (contributory)	804	ATE	0.349			0.08		Significant
Bousmah et al. 2022 [48]	Senegal (non contributory)	983	ATE	0.238			0.12		Significant
Mussa et al. 2023 [49]	Ethiopia	1564	ATE	-0.005	-0.065	0.056			Not Significant
Delivery assisted by skilled attendant
Ravit et al. 2020 [36]	Mauritania	2400	ATE	0.08	0.04	0.12			Significant
Chang et al. 2018 [37]	Rwanda	1913	Odds Ratio	1.158			0.038		Significant
Anindya et al. 2020 [41]	Indonesia	5705	ATT	0.03	0.015	0.045			Significant
Bonfrer et al. 2016 [44]	Ghana	2002	ATT	0.1					Significant
El Omari et al. 2021 [45]	Philippines	3648	ATE	0.234				0.074	Significant
Kofinti et al. 2022 [47]	Ghana	4169	ATE	0.068			0.016		Significant
Mussa et al. 2023 [49]	Ethiopia	1564	ATE	-0.008	-0.072	0.056			Not Significant
C section delivery
Ravit et al. 2020 [36]	Mauritania	1796	ATE	− 0.01	− 0.05	0.03			Not Significant
Philibert et al. 2017 [40]	Mauritania	4029	Absolute risk	− 0.02	-0.04	-0.01			Significant
Bonfrer et al. 2016 [44]	Ghana	2002	ATT	0.06			0.016		Significant
Postnatal care
Rashad et al. 2019 [38]	Egypt	9960	ATT	0.03			0.016		Not Significant
Philibert et al. 2017 [40]	Mauritania	3996	Absolute risk	− 0.01	-0.07	0.05			Not Significant
Anindya et al. 2020 [41]	Indonesia	5705	ATT	0.04	0.022	0.057			Significant
El Omari et al. 2021 [45]	Philippines	3648	ATE	0.093				0.156	Significant
Reduction of OOPE due to delivery
Aizawa 2019 [43]	Indonesia (non-contributory insurance)	3720	ATE	1,136,966 IDR					Significant
Aizawa 2019 [43]	Indonesia (contributory insurance)	3317	ATE	676,402 IDR					Significant
Garg et al. 2023 [50]	India	33,345	ATE	22.89 INR					Not significant

ATE Average treatment effect, ATT Average treatment effect on the treated, IDR Indonesian rupiah, INR Indian rupee

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