Determinants of Health Insurance Non-Enrollment in Guinea: Supply Availability, Awareness and Institutional Trust in the Context of Universal Health Coverage
Abstract:
Health insurance coverage remains very limited in Guinea, slowing progress toward Universal Health Coverage (UHC). This study estimated health insurance coverage among Guinean adults and examined the influence of availability, awareness, affordability, and institutional trust on non enrollment. Methods: Data from the 2024 Afrobarometer Round 10 survey in Guinea (n=1,200; valid insurance status n=1,198) were analyzed using survey weights. Logistic regression identified factors associated with insurance coverage, while multinomial logistic regression, Multiple Correspondence Analysis, and exploratory spatial analysis examined reasons for non-enrollment and regional differences. Results: Only 10.3% of adults reported having health insurance. Among uninsured respondents, the most common reasons for non-enrollment were lack of awareness of existing schemes (30.6%) and absence of available schemes in the area (26.6%). Other barriers included complex enrollment procedures (15.7%), inability to afford membership (7.8%), and distrust of schemes (7.8%). High trust in the Ministry of Health was significantly associated with greater odds of insurance coverage (OR=1.94; 95% CI: 1.26–2.99). Coverage varied substantially across regions, ranging from 2.2% in Faranah to 33.9% in Mamou. Conclusions: Health insurance coverage in Guinea remains very low. Expanding scheme availability, improving public awareness, simplifying enrollment, and strengthening trust in health institutions are essential to accelerate progress toward UHC.References:
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