Health insurance and Out-of-Pocket health care expenditure in Kenya

Abstract Aim/purpose – The aim of this study was to estimate the effect of health insurance on Out-of-Pocket (OOP) health care expenditure in Kenya. It is informed by persistence in the challenges of access and utilization of quality and affordable health care services. Previously, researchers have estimated the effects of different forms of health care financing on its demand and shown that affordability not only enhances access and use of health services but also cushions people against adverse financial risks associated with catastrophic health care spending. Design/methodology/approach – The study used the Kenya Household Health Expenditure and Utilization Survey (KHHEUS) 2013 data, and employed the two-part model estimation approach. The sample size considered in the estimation was 6,961 with the unit of analysis being an individual household member. Findings – The overall results of this study showed that having a health insurance cover did not exclude one from using OOP payments. However, the probability of such spending was low for people with insurance compared to those without insurance. Additionally, if any cash was paid for any health care service, having insurance did not have a significant effect on the level of that spending. Research implications/limitations – The findings of this study imply that uptake of health insurance does not fully cushion people from both using cash payments when seeking health services and ramifications of catastrophic health care spending. The study however, encountered challenges of unavailability of more recent data in the KHHEUS series. In addition, the sample size was relatively small to the population after data cleaning. Originality/value/contribution – Potential effect of health insurance on OOP health care payments had not been explored in Kenya. As such, this study filled this gap. In addition, the two-part model estimation technique was also employed with the latest household health survey data.