Association Between Health Insurance and Access to Universal Health Care in Makueni County, Kenya

Abstract

Background: Universal Health Coverage (UHC) is a global health policy agenda that was endorsed by member states of the World Health Organization (WHO) as one of the 17 Sustainable Development Goals (SDGs) in the year 2015. Developed countries and some Low-and-Middle-Income Countries (LMICs) have been able to achieve UHC through adoption of National Health Insurance Schemes (NHIS) or Community Based Health Insurance (CBHI). Kenya needs other sources of financing mechanisms other than out-of-pocket (OOP) payments to fund its health care system for the achievement of UHC. This study aimed to establish whether adoption of health insurance decreases over reliance on OOP payments for the achievement of UHC. Objective: To assess the association between health insurance and access to UHC. Methods: This was a correlation survey that was conducted in Makueni County. Participants were residents of Makueni Sub-County who were ≥ 18 years. Systematic random sampling was used to select 423 heads of households from 32 health facilities. Outpatient registers for patients above five years old were used as sampling frames to select heads of households as respondents to participate in the study. The interval used to identify respondents was determined by dividing the total number of patients who sought health services from all participating health facilities in the past year at the time of data collection by the sample size. Interviewer administered semi-structured questionnaires were used to collect data from heads of households. Data collected included information on the socio-demographic characteristics of the respondents under study, respondents’ enrollment into health insurance schemes, types of health insurance that respondents are enrolled with as well as access to UHC. Association between the independent variables of socio-demographic characteristics, enrollment into health insurance schemes and types of health

insurance and the dependent variable access to UHC was analyzed through descriptive statistics, Chi-square tests and a statistical mean of access which was calculated to show the direction of association between the variables. Results: The statistical mean of access showed that women had more access to UHC (3.328) than men (3.319). Respondents between the age of 15 and 24 years, those with three or less dependents, had completed secondary school, never been married and were involved in small and medium enterprise (SME) trading as their source of livelihood had the highest access to UHC (3.527, 3.350, 3.355, 3.360, and 3.378, respectively). Age of respondents (χ2 = 43.282, df = 12, p < 0.001), number of dependents (χ2 = 28.109, df = 9, p = 0.001), level of education (χ2 = 27.224, df = 9, p = 0.001) and marital status (χ2 = 22.294, df = 12, p = 0.034) had statistically significant associations with access to UHC. Enrollment into health insurance schemes was influenced by level of income, assessment of personal health status and awareness on benefit of being enrolled into a health insurance scheme. Respondents enrolled with Makueni Care (the local UHC programme in the county) had the highest access to health services (3.347). Enrollment into a health insurance scheme (χ2 = 8.174, df = 3, p = 0.043) and type of health insurance scheme enrolled with (χ2 = 33.255, df = 15, p = 0.004) had statistically significant associations with access to UHC. Conclusion: Enrollment into a health insurance scheme and the type of scheme enrolled with had an influence on access to health services. Embracing health insurance therefore increases access to UHC. Makueni Care has increased access to health services for the residents of Makueni County. Registration for enrollment with the scheme should be decentralized so as to encourage more heads of households to enlist with the health insurance scheme.