Uptake of Healthcare Insurance and Its Associated Factors among Patients Seeking Care at Moi Teaching and Referral Hospital, Eldoret
Arising from the global practice and WHO recommendations, extending access to health care to all segments of the population, including the poor is an important objective of the Kenyan Government’s National Health-Sector Strategic Plan and National Development Agenda as outlined in the Kenya Vision 2030 policy framework (Ministry of Health, 2015). Health insurance is deemed as a means of protecting individuals from incurring high costs at times of illness. It is a potential mechanism for overcoming existing health inequities with consequent effort to promote uptake among the citizens as a way of promoting healthcare. This study examined the factors associated with uptake of healthcare insurance among patients seeking care at Moi Teaching and Referral Hospital, Eldoret, Kenya. A descriptive cross sectional-survey design was adopted involving 234 in-patients and out-patients seeking care at Moi Teaching and Referral Hospital. Stratified and Systematic sampling techniques were applied. Data was collected using structured questionnaires, coded, cleaned and entered into STATA (version 13) for analysis. Descriptive statistics were generated and bivariate analysis to determine factors associated with healthcare insurance uptake were carried out using OR and the Chi-square test. A multiple-logistic model was fitted to adjust for relationships. The study found out that uptake of healthcare insurance cover was a significantly associated with education level, marital status, income of the patients and level of awareness. Uptake of healthcare insurance cover was high among the old (Median = 35, IQR 29, 42) compared to the young (Median = 32, IQR 24, 40), p=0.013. Awareness about of healthcare insurance was associated with, p<0.001, while gender disparity did not show any differentials in uptake, p=0.163. The study concluded that males and the elderly were more likely to be enrolled in healthcare insurance schemes than females and the young. In addition, marital status and education level of an individual positively influenced uptake of healthcare insurance. However, the association between gender and healthcare insurance was not significant. The study further concluded that respondents with higher incomes had a higher likelihood of enrolling in a healthcare insurance scheme as compared to individuals with low income. Awareness about healthcare insurance schemes increased uptake of healthcare insurance. The study recommends the need to encourage women, the unmarried and the young to enroll in healthcare insurance schemes. In addition, insurance agents need to target people with low education levels to scale up uptake and further, healthcare insurance providers to tailor affordable products consistent with income differentials.
Bending, M. &. (2011). Enrollment in Micro life and Health Insurance: Evidence from Sri-Lanka. IZA DP NO , 5427.
Bhat, R., & Jain, N. (2006). Factors influencing the demand for health insurance in a micro insurance scheme. Indian Institute of Management .
Boateng, & Awunyor, V. (2013). Health Insurance in Ghana: An evaluation of policy holder's perceptions and factor influencing policy renewal in Volta region. International Joiurnal of Equity in Health , 12, 50.
Bonfrer, I., & Gustafsson-Wright, E. (2015). Hrealth Shocks, Coping Strategies and Foregone Healthcare among Agricultural Households in Kenya. Global Public Health , 1-22.
Bourne, P. &. (2010). Determinants of Self-Realated Private Health Insurance Coverage in Jamaica. Health , 2, 541-550.
Buigut, S., Ettarh, R., & Amendah, D. (2015). Catastrophic Health Expenditure and its Determinants in Kenya Slum Communities. International Journal for Equity in Health , 14 (46).
Carrin, G. (2003). Community based Health Insurance Schemes in Developing Countries: facts, problems and perspectives.
Carrin, G., Mathauer, I., Ke, X., & Evans, D. B. (2010). Universal Coverage of Health Services: Tailoring its Implementation. Tropical Medicine and International Health , 10, 799-811.
Chuma, J., & Okungu, V. (2011). Viewing the Kenyan Health System through and Equity Lens: Implications for Universal Coverage. International Journal for Equity in Health , 10 (22), 1-14.
Dalaba, M., Akweongo, P., Aborigo, R., & Ataguba, J. (2012). Insure or not insure: The influence of insurance status on health seeking behaviour in the Kassena-Nankana District of Ghana. African Journal of Health Science , 21 (3).
Fang, K. B. (2012). Health Insurance Coverage, Medical Expenditure Coping Strategy: Evidence from Taiwan. BMC Health Service research , 12, 442.
Feinstein, L., Ricardo, S., Tashweka, M., Annik, S., & Cathie, H. (2006). Effects of Education on Health.
Gina, L & Sapna, S.K. (2008). Overcoming the challenges of scaling voluntary risk pools in low income settings. Technical paper , No 6.
Hoerl, M., Wuppermann, S., Barcellos, S., Bauhoff, J., Winter, K., & Carman, K. (2017). Knowledge as a Predictor of Insurance Coverage Under the Affordable Care Act. Medical Care , 55 (4).
Isaac, O., & Clement, A. (2011). Health Insirance and Vulnerability to Health Shocks in Ghana. Institute of Statistical and Economic Research (ISSER), University of Ghana .
Jangati, Y. (2012). Awareness of health insurance in Andra Pradesh. International Journal of Scientific and Research publications , 2(6) 161-178.
Kazungu, J., & Barasa, E. (2017). Examining levels, distribution and correlates of health insurance coverage in Kenya. Tropical Medicine & International Health , 22 (9), 1175-1185.
Kirigia, J., Sambo, B., Dermano'Rufaro, C., & Takondwa, M. (2005). Determinants of Health Insurance Ownership among South African Women. BMC Health Services Research , 5, 11.
Kusi, A., Enemark, U., Hansen, K., & Asante, F. (2015). Refusal to Enroll in Ghana's National Health Insurance Scheme; is affordability the problem? International Journal for Equity in Health , 14 (2), 17-17.
Liaropoulos, L., & Goranitis, I. (2016). Healthcare Financing and Sustainability of Health Systems. International Journal of Equity in Health , 1-4.
Maina, J. K. (2016). Perceptions and Uptake of Health Insurance for maternal care in rura Kenya: A cross sectional study. The Pan African Medical Journal , 23-25.
Mathauer, I., Schmidt J, O., & Wenyaa, M. (2008). Extending Social Health Insurance to the Informal Sector in Kenya: an assessment of factors affecting demand. International Journal of Health Planning and Management, US NAtional Library of Medicine , 23 (1), 51-68.
McIntyre, D. (2007). Learning from experience: Healthcare financing in low and middle income countries. Geneva: Global forum for health research .
Mhere, F. (2013). Health Insurance Determinants in Zimbabwe: A case of Gweru Urban. Journal of Applioed Business and Economics , 14 (2), 62-79, 113-119
Mills, A., Ataguba, J., Akazili, J., Garshong, B., & Makawia, S. (2012). Equity in financing and use of health care in Ghana, South Africa and Tanzania: Implications for paths of Universal Coverage. Lancet , 1, 26-33.
Ministry of Health. (2014). Kenya Household Health Expenditure and Utilization Survey. Nairobi: Ministry of Health.
Ministry of Health. (2015). Kenya National Health Accounts. Nairobi: Ministry of Health
Mulupi, S., Kiriga, D., & Chuma, J. (2013). Community Perceptions of Health Insurance and their preferred design of features: Implications for the design of Universal Health Coverage Reforms in Kenya. BMC Health Services Research , 13 (474).
Munge, K., & Harvey, A. B. (2014). The Progressivity of Healthcare Financing in Kenya. Health Policy and Planning, London School of Hygiene and Tropical Medicine , 29 (7), 912-920.
Omondi, D. (2009). Knowledge, Perceptions and Attitude of Health managers towards the Proposed Health Insurance Scheme in Uganda. Health policy and Development , 7 (1) 10-16.
Sabine, C. (2012). Gender Equality in Access to Healthcare: The role of social health protection, a case study of RSBY Scheme. GIZ Discussion Papers on Social Protection .
W.H.O. (2010). Health Systems Financing: The Path to Universal Coverage. The World Bank Report