Determinants of Health Insurance Coverage in Rwanda: A Nationally Representative, Survey-Weighted Analysis of the 2023/2024 Seventh Integrated Household Living Conditions Survey (EICV7)

Abstract Background Rwanda has expanded health insurance enrolment to among the highest levels in sub-Saharan Africa, primarily through the Community-Based Health Insurance scheme (Mutuelle de Santé). Whether this near-universal coverage is distributed equitably across demographic and socioeconomic groups, and which individual- and household-level factors continue to drive non-enrolment, remains insufficiently characterized using the most recent national survey round. This study assessed the distribution of health insurance coverage across individual profile characteristics and identified the determinants of insurance coverage countrywide. Methods A cross-sectional analysis was used for individual-level microdata on 62,058 respondents from the 2023/2024 Seventh Integrated Household Living Conditions Survey (EICV7). A survey-weighted logistic regression model (quasibinomial family, logit link) accounting for primary sampling units, strata, and household sampling weights was fitted to estimate adjusted odds ratios (aOR) for insurance coverage across sex, age, marital status, residence area, education, economic activity, income, welfare (Ubudehe) category, consumption quintile, internet use, recent illness, and recent health consultation. Results A weighted health insurance coverage of 85.3% was observed among the sampled respondents, whereby tertiary education (aOR 7.58), the highest consumption quintile (aOR 4.45), and internet use (aOR 2.62) were the strongest independent predictors of coverage. Crucially, once socioeconomic factors were controlled, residence area (urban vs. rural) was no longer a significant predictor, suggesting that earlier urban–rural gaps were driven by underlying wealth and education differences rather than geography per se. Conclusions Health insurance coverage in Rwanda remains high but follows a clear socioeconomic and educational gradient. Strengthening enrolment among the least-educated, poorest, and least digitally connected populations, and reinforcing linkages between routine health contacts and enrolment, are priorities for sustaining progress toward universal health coverage.