Beneficiaries' satisfaction with health insurance and associated factors in Sub-Saharan Africa: a systematic review and meta-analysis.

Abstract

Beneficiaries' satisfaction with health insurance schemes is crucial for the success of these programmes, influencing their effective implementation and reducing dropout rates. This systematic review and meta-analysis aimed to assess the proportion of beneficiaries satisfied with health insurance and identify factors associated with their satisfaction in Sub-Saharan Africa (SSA). A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. PubMed/MEDLINE, African Journals Online, Cumulative Index to Nursing & Allied Health Literature and Google Scholar were searched up to 23 May 2024. Observational and quantitative studies conducted in SSA that reported the proportion of health insurance beneficiaries satisfied with the scheme and/or determined factors associated with satisfaction were included. Data were extracted using Microsoft Excel and analysed with STATA V.17 software. The quality of studies was assessed using Joanna Briggs Institute checklists. A random-effects model was employed to estimate pooled outcomes. Publication bias was evaluated with a funnel plot and Egger's regression test, while heterogeneity was assessed using the I² statistic. The study included 29 primary studies with a total of 11,488 participants. Among the included studies, 17 (58.62%) were found to have a low risk of bias, while the remaining studies exhibited a moderate risk of bias. The findings suggested publication bias among the included studies. To address this, a trim-and-fill analysis imputed 10 hypothetical missing studies, resulting in a more symmetrical funnel plot. The pooled finding showed that 61.84% of beneficiaries were satisfied with their health insurance (95% CI: 55.14 to 68.55, (I²=98.6%, p<0.001)). Having a good knowledge of health insurance (OR=2.75, 95% CI: 1.42 to 5.34, (I²=95.3%, p<0.001)), availability of prescribed drugs (OR=5.69, 95% CI: 3.04 to 10.62, (I²=88.6%, p<0.001)) and availability of lab services (OR=4.20, 95% CI: 2.18 to 8.11, (I²=88.4%, p<0.001)) were significantly associated to higher satisfaction with health insurance. The results of this review show that a significant number of beneficiaries are satisfied with their health insurance. The findings highlight that beneficiaries' satisfaction is significantly influenced by their knowledge of health insurance, as well as the availability of prescribed drugs and essential laboratory services. It is recommended that health insurance programmes in SSA focus on these factors to improve overall satisfaction among beneficiaries. CRD42024496847.