Determinants of coverage and utilization of health insurance schemes among adult residents of Bungoma town, Kenya

Abstract

ABSTRACT: Increasing cost of health care remains a major challenge to achieving universal health care coverage in many developing countries. Health insurance schemes can be used to finance health care and protect people against catastrophic health care expenses. Most developing countries have low insurance coverage and rely on out of pocket health payments. Despite having 22 private and one public health insurance, only 17% of Kenya’s population had insurance cover while out of pocket expenditure on health was 32%.Moreover, 91% of in-patients admitted at Bungoma County Referral Hospital between January 1st 2012 and December 31st 2012 paid through out of pocket method. Information on determinants of coverage and utilization of health financing schemes in Bungoma Town is uncertain. The main objective of this study was to establish determinants of coverage and utilization of health insurance schemes with specific objective of determining coverage, utilization and establishing sociodemographic and economic factors associated with coverage and utilization of health insurance among adult residents of Bungoma Town. A cross-sectional design was adopted for the study and quantitative data was collected using questionnaires. Probability proportionate to size sampling method was used to select 414 participants from target population of 15204 from four admitting hospitals in Bungoma Town. Chi-square test for independence and logistic regression analysis was used to test the association between independent and dependent variables. All tests were two-tailed and a P-value < 0.05 was considered statistically significant. Out of 414 respondents half 212(51.20%) had health insurance cover and 185(87.3%) utilized it. Sociodemographic factors such as age(26-45 years) OR = 2.745, (95% CI = 1.203 - 6.264), P = 0.016, marital status(Married)OR = 6.268 ; (95% CI = 2.065 - 19.024); P ≤ 0.001;and economic factors such as university and middle level college education OR = 25.500; (95% CI = 1.721 - 377.934); P = 0.019 and OR = 13.600; (95% CI = 1.367 - 135.302) P = 0.026, respectively, formal sector employment OR = 15.401; (95% CI = 6.524 - 36.360); P <0.001 and high income ( 26001 - 50000 ) OR = 38.3333 (95% CI = 48.388 - 3036.825; P <0.001 significantly influenced health insurance coverage and utilization .This study has shown that health insurance coverage and utilization in Bungoma Town is low. Females, those with higher education and high income tended to have insurance cover more than the rest hence need to step up education on the importance of having health insurance to rest of the people.