Gender inequities in public health insurance programs: a scoping review of the literature

Many governments have undertaken publicly funded/administered health insurance programs to achieve universal, equitable healthcare access, yet there is evidence that they may overlook women. This scoping review assesses how gender inequities manifest in public health insurance programs. We conducted a comprehensive search of peer-reviewed articles in three databases, as well as a targeted search of grey literature published in English between 2013-2025. Data were extracted using a piloted abstraction tool and findings were reported in narrative synthesis. Of the twenty publications included, ten featured programs in India, three in Kenya, two in China and Rwanda, and one in Ghana, Indonesia, and Kyrgyz Republic. Fourteen quantified gender differentials in enrollment/utilization and sixteen assessed gendered barriers to uptake/utilization. We found evidence that women were often less likely to enroll/utilize public health insurance programs, with intersectional vulnerabilities documented among disabled, elderly, and unmarried women. Studies pointed to three types of barriers to women’s enrollment and utilization: individual/household, facility/provider, and insurance program design, rollout, and administration, many of which can be redressed through gender-responsive considerations in program design and implementation. Failure to adequately address the ways public health insurance reforms can exclude women risks undermining the long-term effectiveness of these programs. • Women and girls, particularly those who are poor and marginalized, face a range of unique challenges that hamper their enrollment and access to health insurance programs Barriers manifesting at the individual/household, facility/provider, and insurance system levels can prevent women and girls from enrolling and utilizing health insurance. • Public health insurance programs are often not designed with specific considerations for gender inequalities. • Incorporation of gender-responsive considerations across health financing functions (financing, pooling, purchasing and provision) is important to ensure that UHC (Universal Health Coverage) is truly universal, and women are not left behind.