The Association of Health Insurance with institutional delivery and access to skilled birth attendants: evidence from the Kenya Demographic and health survey 2008–09

Abstract

BackgroundHealthcare financing through health insurance is gaining traction as developing countries strive to achieve universal health coverage and address the limited access to critical health services for specific populations including pregnant women and their children. However, these reforms are taking place despite limited evaluation of impact of health insurance on maternal health in developing countries including Kenya. In this study we evaluate the association of health insurance with access and utilization of obstetric delivery health services for pregnant women in Kenya.MethodsNationally representative data from the Kenya Demographic and Health Survey 2008–09 was used in this study. 4082 pregnant women with outcomes of interest - Institutional delivery (Yes/No – delivery at hospital, dispensary, maternity home, and clinic) and access to skilled birth attendants (help by a nurse, doctor, or trained midwife at delivery) were selected from 8444 women ages 15–49 years. Linear and logistic regression, and propensity score adjustment are used to estimate the causal association of enrollment in insurance on obstetric health outcomes.ResultsMothers with insurance are 23 percentage points (p < 0.01) more likely to deliver at an institution and 20 percentages points (p < 0.01) more likely have access to skilled birth attendants compared to those not insured. In addition mothers of lower socio-economic status benefit more from enrollment in insurance compared to mothers of higher socio-economic status. For both institutional delivery and access to skilled birth attendants, the average difference of the association of insurance enrollment compared to not enrolling for those of low SES is 23 percentage points (p < 0.01), and 6 percentage points (p < 0.01) for those of higher SES.ConclusionsEnrolling in health insurance is associated with increased access and utilization of obstetric delivery health services for pregnant women. Notably, those of lower socio-economic status seem to benefit the most from enrollment in insurance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2397-7) contains supplementary material, which is available to authorized users.

Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention

“…The descriptive analysis shows that insurance enrollment among HIV positive pregnant women is low. The low insurance enrollment is consistent with national level estimates that show similarly low enrollments rates (11%) among pregnant women in the general Kenyan population [43]. Being Lost to-follow-up to HIV care during pregnancy and receiving care at an urban clinic are positive predictors of insurance enrollment.…”

“…Established by an Act of Parliament in 1966, the NHIF is the oldest Social Health Insurance (SHI) in sub-Saharan Africa [43] and the largest health insurer in Kenya, with private health insurance covering about 2% of the population [38]. Over the next 30 years, NHIF has instituted reforms to expand coverage.…”

Effects of social health insurance on access and utilization of obstetric health services: results from HIV+ pregnant women in Kenya

“…In SSA, Kenya offers a good opportunity to study the congruence of SHI, reproductive health and HIV related health outcomes as Kenya has been flagged as having potential to lead Africa towards UHC [23] [24]. Notably, Kenya has the oldest SHI in SSA: the National Hospital Insurance Fund (NHIF) [25] [26] and the 4th largest global HIV epidemic that is feminized as prevalence among women is 6.3% compared to men at 5.5% [27] [28].…”

Satisfaction with Delivery Services Offered under the Free Maternal Healthcare Policy in Kenyan Public Health Facilities

“…Unaffordable health services globally are a result of inadequate health financing care models which often result in catastrophic expenditures throughout pocket payments for health services [10–16]. At the 13th of December 2017, at least half of the world's population could not access essential health services due to cost implications while 800 million people globally spend at least 10 percent of their household budgets on health expenses for family members [17].…”

“…Economic related reasons are a significant barrier to delivering at health facilities in many regions in Kenya [15, 16]. Previous assessments in Kenya have established that up to 11% of women do not deliver in health facilities due to the cost of skilled delivery services [20].…”