Examining levels, distribution and correlates of health insurance coverage in Kenya

Abstract

ObjectiveTo examine the levels, inequalities and factors associated with health insurance coverage in Kenya.MethodsWe analysed secondary data from the Kenya Demographic and Health Survey (KDHS) conducted in 2009 and 2014. We examined the level of health insurance coverage overall, and by type, using an asset index to categorise households into five socio‐economic quintiles with quintile 5 (Q5) being the richest and quintile 1 (Q1) being the poorest. The high–low ratio (Q5/Q1 ratio), concentration curve and concentration index (CIX) were employed to assess inequalities in health insurance coverage, and logistic regression to examine correlates of health insurance coverage.ResultsOverall health insurance coverage increased from 8.17% to 19.59% between 2009 and 2014. There was high inequality in overall health insurance coverage, even though this inequality decreased between 2009 (Q5/Q1 ratio of 31.21, CIX = 0.61, 95% CI 0.52–0.0.71) and 2014 (Q5/Q1 ratio 12.34, CIX = 0.49, 95% CI 0.45–0.52). Individuals that were older, employed in the formal sector; married, exposed to media; and male, belonged to a small household, had a chronic disease and belonged to rich households, had increased odds of health insurance coverage.ConclusionHealth insurance coverage in Kenya remains low and is characterised by significant inequality. In a context where over 80% of the population is in the informal sector, and close to 50% live below the national poverty line, achieving high and equitable coverage levels with contributory and voluntary health insurance mechanism is problematic. Kenya should consider a universal, tax‐funded mechanism that ensures revenues are equitably and efficiently collected, and everyone (including the poor and those in the informal sector) is covered.

Patient costs of hypertension care in public health care facilities in Kenya

“…48,49 Our results show that three quarters of sampled hypertensive patients were not subscribed to any health insurance scheme reflecting coverage levels at a national level in Kenya where 80% of the population are not covered by any health insurance scheme. 17,19 This is similar to findings made by Kankeu et al 5 in a review of financial burden of NCDs in LMICs. This means that hypertensive patients, especially those belonging to the lower rungs of the income ladder, bear a disproportionately higher burden of OOP, hence making them certain candidates to "medical poverty trap" where poor patients have to cope with the effect of reduced disposable income for other consumptions, which in turn increases poverty.…”

“…One of the interventions for achieving the UHC goal of financial risk protection being pursued in Kenya and other LMICs is expansion of coverage under prepayment schemes such as social health insurance . Our results show that three quarters of sampled hypertensive patients were not subscribed to any health insurance scheme reflecting coverage levels at a national level in Kenya where 80% of the population are not covered by any health insurance scheme . This is similar to findings made by Kankeu et al in a review of financial burden of NCDs in LMICs.…”

“…16 In addition, it has been shown that households with a member with an NCD are two times more likely to incur catastrophic health expenditure compared with households where no member has an NCD. 16 A minority of individuals (19%) in Kenya have health insurance coverage, 17 and almost all employees in the formal sector, which is less than one-fifth of those employed, are covered through the National Hospital Insurance Fund (NHIF). 18,19 Several studies done in Kenya have identified a high prevalence of hypertension (ranging from 12.3% to 50.1%).…”

Patient costs of diabetes mellitus care in public health care facilities in Kenya

“…The incidence of catastrophic costs documented in this study is arguably high and suggests that DM care in the sampled health facilities is unaffordable to majority of patients, especially those in the lowest wealth quintile whose capacity to pay is limited compared with those in higher socio‐economic group. This is a concern given the high poverty rates in Kenya (36.1%) and that only 19% of Kenya's population have a form of health insurance . Furthermore, a past study has shown that families with a member with an NCD incurs three times higher costs compared with families without a member with an NCD .…”

Implementation of an Ultraviolet Phototherapy Service at a National Referral Hospital in Western Kenya: Reflections on Challenges and Lessons Learned

“…Common skin conditions include tinea versicolor, tinea capitis, scabies, atopic dermatitis, psoriasis, vitiligo, acne vulgaris, and dermatitis [5,6]. The National Hospital Insurance Fund (NHIF) is the main health insurer, covering 16% of Kenyans [7]. NHIF contribution is mandatory for formal sector workers and voluntary for informal sector workers.…”