Volume 2, Issue 4, December 2017, Page: 145-151
Determinants of Uptake of Health Insurance Cover Among Adult Patients Attending Bungoma County Referral Hospital
Nathan Lukhale Masengeli, School of Medicine and Health Science, Kenya Methodist University, Nairobi, Kenya
Wanja Mwaura-Tenambergen, School of Medicine and Health Science, Kenya Methodist University, Nairobi, Kenya
Joseph Mutai, Kenya Medical Research Institute, Nairobi, Kenya
Ben Wafula Simiyu, Kenya Medical Training College, Eldoret, Kenya
Received: Apr. 19, 2017;       Accepted: May 15, 2017;       Published: Jul. 12, 2017
DOI: 10.11648/j.hep.20170204.11      View  1880      Downloads  150
Abstract
Health insurance is currently being considered as a mechanism for promoting progress to Universal health Coverage and reducing out-of-pocket payments in many African countries including Kenya which is prompting the use of NHIF. In Kenya, penetration of health insurance is 20% and 11% in Bungoma County. The main objective of the study was to establish the scheme-related factors influencing uptake of health insurance cover among patients attending Bungoma County Referral hospital. The study adopted across sectional descriptive survey of 300 systematically sampled patients, 4 purposively sampled departmental heads in Bungoma County Referral Hospital and all the 5 insurance company branch managers. Data was collected using questionnaires administered and Key Informant Interview schedule. Crude odds ratio was used to establish association between ownership of health insurance and scheme-related factors. Findings showed that 37% of patients owned health insurance covers mostly public health insurance cover (NHIF). Ownership of health insurance covers increased with age, household income, education levels, awareness of insurance benefits and concepts. Covers were also more prevalent among married patients. Ownership of health insurance covers increased 12.5 times with affordability of covers premiums. Stock-out of essential drugs and supplies and longer waiting time in covered health facilities discouraged enrollment to schemes.
Keywords
Health Insurance Cover, Patient-Factors, Cover Benefits, Cover Accessibility, Perceived Cover Quality
To cite this article
Nathan Lukhale Masengeli, Wanja Mwaura-Tenambergen, Joseph Mutai, Ben Wafula Simiyu, Determinants of Uptake of Health Insurance Cover Among Adult Patients Attending Bungoma County Referral Hospital, International Journal of Health Economics and Policy. Vol. 2, No. 4, 2017, pp. 145-151. doi: 10.11648/j.hep.20170204.11
Copyright
Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Evans DB, Hsu J, Boerma T. Universal health coverage and universal access. Bulletin of the World Health Organization. 2013; 91: p. 546-546A.
[2]
Liaropoulos L, Goranitis I. Health care financing and the sustainability of health systems. International Journal for Equity in Health. 2016; 14 (80): p. 1-4.
[3]
Bustreo F. World Health Organization. [Online]; 2015 [cited 2016 June 21. Available from: http://www.who.int/life-course/news/commentaries/financing-health-sustainable-goal/en/.
[4]
Fox AM, Reich MR. The Politics of Universal Health Coverage in Low- and Middle-Income Countries: A Framework for Evaluation and Action. Journal of Health Politics, Policy and Law. 2015; 40 (5): p. 1023-1060.
[5]
Kusi A, Enemark U, Hansen KS, Asante FA. Refusal to enrol in Ghana’s National Health Insurance Scheme: is affordability the problem? International Journal for Equity in Health. 2015 January 17; 14 (2).
[6]
World Bank. World Bank. [Online]; 2015 [cited 2016 June 18. Available from: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS.
[7]
Chuma J, Okungu V. Viewing the Kenyan health system through an equity lens: implications for universal coverage. International Journal for Equity in Health. 2011; 10 (22): p. 1-14.
[8]
Chuma J, Maina T, Ataguba J. Does the distribution of health care benefits in Kenya meet the principles of universal coverage? BMC Public Health. 2012; 12 (20).
[9]
Barasa EW, Maina T, Ravishankar N. Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya. International Journal for Equity in Health. 2017; 16 (31): p. 1-14.
[10]
Mulupi S, Kirigia D, Chuma J. Community perceptions of health insurance and their preferred design features: implications for the design of universal health coverage reforms in Kenya. BMC Health Services Research. 2013; 13 (474).
[11]
Buigut S, Ettarh R, Amendah DD. Catastrophic health expenditure and its determinants in Kenya slum communities. International Journal for Equity in Health. 2015; 14 (46).
[12]
Mhere F. Health insurance determinants in Zimbabwe: Case of Gweru Urban. Journal of Applied Business and Economics. 2013; 14 (2): p. 62-79.
[13]
Schneider P. Why should the poor insure? Theories of decision-making in the context of health insurance. Health Policy and Planning. 2004; 19 (6): p. 349-355.
[14]
Deloitte. A Strategic Review of NHIF and Market Assessment of Private Prepaid Health Schemes. Nairobi: 2011.
[15]
Ministry of Health [MoH]. 2013 Kenya Household Health Expenditure and Utilisation Survey. Nairobi: 2014.
[16]
Bonfrer I, Gustafsson-Wright E. Health shocks, coping strategies and foregone healthcare among agricultural households in Kenya. Global Public Health. 2015; p. 1-22.
[17]
Kipaseyia JS. Factors influencing membership uptake of National Hospital Insurance Fund among the poor: a pastoralist’ perspective. Master's Thesis. Nairobi, Kenya: Strathmore University, Strathmore Business School; 2016.
[18]
Bolhaar J, Lindeboom M, Klaauw Bvd. A Dynamic Analysis of the Demand for Health Insurance and Health Care. IZA DP No. 3698. Bonn, Germany: 2008.
[19]
Kimani JK, Ettarh R, Kyobutungi C, Mberu B, Muindi K. Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey. BMC Health Services Research. 2012; 12 (66).
[20]
Maina JM, Kithuka P, Tororei S. Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study. The Pan African Medical Journal. 2016; 23 (125): p. 1-10.
[21]
Jehu-Appiah C, Aryeetey G, Agyepong I, Spaan E, Baltussen R. Household perceptions and their implications for enrolment in the National Health Insurance Scheme in Ghana. Health Policy and Planning. 2011; 27 (3): p. 222-233.
[22]
Kimani JK, Ettarh R, Warren C, Bellows B. Determinants of health insurance ownership among women in Kenya: evidence from the 2008–09 Kenya demographic and health survey. International Journal for Equity in Health. 2014; 13 (27).
[23]
Owando S. Factors Influencing the Demand for Health Insurance in Kenya: A Case Study of Nairobi City. MA Research Paper. Nairobi; 2006.
[24]
Kiplagat I, Muriithi M, Kioko U. Determinants of Health Insurance Choice in Kenya. European Scientific Journal. 2013; 9 (13): p. 452-468.
[25]
Ibok NI. Socio-Economic and Demographic Determinants of Health Insurance Consumption. Canadian Social Science. 2012; 8 (5): p. 64-70.
[26]
Amu H, Dickson KS. Health insurance subscription among women in reproductive age in Ghana: do socio-demographics matter? Health Economics Review. 2016; 6 (24).
[27]
Chankova S, Sulzbach S, Diop F. Impact of mutual health organizations: evidence from West Africa. Health Policy Planning. 2008; 23 (4): p. 264–276.
[28]
Dixon J, Tenkorang EY, Luginaah I. Ghana’s National Health Insurance Scheme: a national level investigation of members’ perceptions of service provision. BMC International Health and Human Rights. 2013; 13 (35).
[29]
Adebayo EF, Uthman OA, Wiysonge CS, Stern EA, Lamont KT, Ataguba JE. A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries. BMC Health Services Research. 2015; 15 (543).
[30]
Van Winssen KPM, van Kleef RC, van de Ven WPMM. The demand for health insurance and behavioural economics. The European Journal of Health Economics. 2016; 17 (6): p. 653–657.
[31]
Thornton RL, Hatt LE, Field EM, Islam M, Diaz FS, González MA. Social security health insurance for the informal sector in Nicaragua: a randomized evaluation. Health Economics. 2010; 19 (Supplement 1): p. 181–206.
[32]
Namuhisa JA. Determinants of Uptake of National Hospital Insurance Fund Scheme by the Informal Sector in Nairobi County, Kenya. Thesis. Nairobi: Kenyatta University, Department of Business Administration; 2014.
[33]
Nyorera EN, Okibo W. Factors Affecting Uptake of National Hospital Insurance Fund among Informal Sector Workers a Case of Nyatike Sub-County, Kenya. International Journal of Economics, Commerce and Management. 2015; III (3): p. 1-18.
[34]
Jacobs B, Ir P, Bigdeli M, Annear PL, Damme WV. Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy and Planning. 2011; 27 (4): p. 1-13.
[35]
Borbjerg RR, Hadley J. Why health insurance is important. Health policy brief. 2007.
[36]
Panda P, Dror I, Koehlmoos TP, Shahed SAH, John D, Khan JAM, et al. What factors affect take up of voluntary and community based health insurance programmes in low- and middle- income countries? Protocol. London: University of London, Institute of Education; 2013.
[37]
Mathauer I, Schmidt JO, Wenyaa M. Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand. The International Journal of Health Planning and Management. 2008; 23 (1): p. 51–68.
[38]
Alhassan RK, Duku SO, Janssens W, Nketiah-Amponsah E, Spieker N, Ostenberg Pv, et al. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana. PLOS ONE. 2015; 10 (10): p. e0140109.
[39]
Aggrey M, Appiah SCY. The influence of clients’ perceived quality on health care utilization. International Journal of Innovation and Applied Studies. 2014; 9 (2): p. 918-924.
[40]
Gobah FK, Liang Z. The National Health Insurance Scheme in Ghana: Prospects and Challenges: A Cross-Sectional Evidence. Global Journal of Health Science. 2011; 3 (2).
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