The Self-Reported Health Status, Chronic Disease Burden and Healthcare Utilisation of Uninsured Rural Residents in Jamaica: Evidence from the Jamaica Survey of Living Conditions 2023

Vollständiger Abstract

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Background: Health insurance constitutes an important component of financial protection because illness can impose direct medical costs on households while simultaneously reducing income through disability and lost productivity. Rural populations may experience an additional disadvantage because socioeconomic vulnerability, employment arrangements, geographical accessibility and availability of health services can interact with insurance status to influence healthcare utilisation. Although Jamaican scholarship has examined rural health and health insurance, comparatively little contemporary evidence has isolated uninsured rural residents and simultaneously examined their socioeconomic composition, functional health, current illness, chronic disease history and utilisation of health professionals. This omission is consequential because favourable self-reported health may coexist with chronic morbidity and functional limitation, creating a potentially misleading impression of health among populations without financial protection. Objective: This study examined the demographic, socioeconomic and health characteristics of uninsured rural Jamaicans using the Jamaica Survey of Living Conditions (JSLC) 2023 and compared the findings with Jamaican and international evidence. Methods: A secondary cross-sectional analysis of JSLC 2023 microdata was undertaken among 1,583 rural residents reporting no health insurance, using descriptive frequencies and percentages for demographic characteristics, functional health, illness status, healthcare utilisation and reported chronic conditions. Results: Males represented 50.9% of the sample, 54.5% were classified in the two poorest consumption quintiles, and 56.8% of respondents with valid employment data were own-account workers. Although 97.0% reported that they were not currently ill and 82.2% of respondents with valid functional-health information reported no functional difficulty, 17.8% experienced at least some functional limitation, while hypertension (17.8%), diabetes (7.5%), asthma (6.5%) and arthritis (6.3%) constituted the leading reported chronic conditions. Among the 57 respondents with valid healthcare-utilisation information, 71.9% had visited a doctor, nurse or pharmacist, whereas 28.1% had not. Conclusion: Uninsured rural Jamaicans cannot be characterised simply as a predominantly healthy population because low current self-reported illness coexists with chronic disease, functional limitation and socioeconomic vulnerability. The findings indicate the analytical importance of distinguishing feeling currently ill, living with chronic disease and experiencing functional limitation when assessing health need among uninsured populations.