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

OBJECTIVE: To examine the levels, inequalities and factors associated with health insurance coverage in Kenya. METHODS: We 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,...

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Autores principales: Kazungu, Jacob S., Barasa, Edwine W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599961/
https://www.ncbi.nlm.nih.gov/pubmed/28627085
http://dx.doi.org/10.1111/tmi.12912
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author Kazungu, Jacob S.
Barasa, Edwine W.
author_facet Kazungu, Jacob S.
Barasa, Edwine W.
author_sort Kazungu, Jacob S.
collection PubMed
description OBJECTIVE: To examine the levels, inequalities and factors associated with health insurance coverage in Kenya. METHODS: We 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. RESULTS: Overall 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. CONCLUSION: Health 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.
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spelling pubmed-55999612017-10-02 Examining levels, distribution and correlates of health insurance coverage in Kenya Kazungu, Jacob S. Barasa, Edwine W. Trop Med Int Health Original Research Papers OBJECTIVE: To examine the levels, inequalities and factors associated with health insurance coverage in Kenya. METHODS: We 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. RESULTS: Overall 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. CONCLUSION: Health 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. John Wiley and Sons Inc. 2017-07-05 2017-09 /pmc/articles/PMC5599961/ /pubmed/28627085 http://dx.doi.org/10.1111/tmi.12912 Text en © 2017 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research Papers
Kazungu, Jacob S.
Barasa, Edwine W.
Examining levels, distribution and correlates of health insurance coverage in Kenya
title Examining levels, distribution and correlates of health insurance coverage in Kenya
title_full Examining levels, distribution and correlates of health insurance coverage in Kenya
title_fullStr Examining levels, distribution and correlates of health insurance coverage in Kenya
title_full_unstemmed Examining levels, distribution and correlates of health insurance coverage in Kenya
title_short Examining levels, distribution and correlates of health insurance coverage in Kenya
title_sort examining levels, distribution and correlates of health insurance coverage in kenya
topic Original Research Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599961/
https://www.ncbi.nlm.nih.gov/pubmed/28627085
http://dx.doi.org/10.1111/tmi.12912
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