The effects of cost-sharing on health services provision in public hospitals in Kenya: a case study of Kangundo District, Eastern Kenya
The focus of this study was to determine the effects of cost-sharing on healthcare services provision in public hospitals in Kenya by examining a case study of Kangundo District Hospital in the Eastern Provision of Kenya. In this regard, the study was guided by three objectives, namely: a) To establish whether cost sharing led to a diverting demand of health care from public to private health care providers in Kangundo District. b) To determine how aspects on ability to pay by patients affect revenue generation by health care facilities in Kangundo, and c) find out how user fee charging has affected household access to health care services from public health care facilities in Kangundo Two hypotheses were tested in this study. The first hypothesis stated that the demand for healthcare services offered in hospitals in Kangundo District was influenced by the social demographic backgrounds of patients. The second hypothesis postulated that cost shari1\gon health care had led to provision of quality health care by public health facilities in Kangundo District. The study was conducted out in Kangundo District, Eastern Kenya which covers an area of 178.2 km2 Survey research design was used to collect data and was supplemented by field research (qualitative approach). 150 household heads were sampled to generate quantitative data while 10 health care providers from Kangundo District Hospital were interviewed as key informants. A standardized questionnaire was used to interview household heads in the three research sites. Multi-stage cluster sampling was used to select household heads while non-probability (purposive) sampling was used in the selection of the three locations and three sub-locations, respectively. An interview guide was used to collect qualitative data from the key informants. The researcher supplemented quantitative and qualitative data with observational data which he collected during the ,fieldwork. The findings of this study are based on two levels of analysis viz. univariate and multivariate regression. The study has used multiple regression analysis and applied inferential statistics (such as regression coefficient and P- Value) in testing its two hypotheses. The study established that the introduction of cost sharing has not led to diverting demand of health care from public to private health care providers in Kangundo District, though patients still utilized private health care facilities in the district. Patients in Kangundo District utilized public health care facilities more than private ones. This means that public hospitals were popular compared to private ones. Another finding of the study was that the study established that the patients preferred public health care facilities since the charges were comparatively cheaper. The data generated indicated that 92% of respondents in Kangundo were not in reliable employment. This means that they did not have the ability to pay for health care and therefore this affected revenue generation. User fee charging has an effect on household access to health care in Kangundo District. The low income status of respondents meant that they can ill-afford to pay for health care and meet other family needs like the basic necessities. The respondents might not find it 'easy to access health care facilities due to proximity of the health care facility. This is because patients consider the costs incurred in acquiring health care services. The researcher makes the following recommendations: The hospital management committee should ensure that the revenue generated is fully utilized to ensure that public health care facilities can provide quality health so as to ensure that there was no diversion of demand for health care. Public hospital should provide safety nets to ensure that patients who are unable to pay for health care are catered for. The government needs to provide means to cushion the residents of Kangundo from poverty so as to give them the purchasing power. More health care facilities should be constructed to ensure even access of health care services by patients. Government budgetary allocations should cater for health care infrastructure in the district. There is need for further research on situation analysis on Health Insurance programs as a supplement to cost sharing in health ,are, factors that influence health-seeking decisions at the household level; as well as in the potential for enhancing alternative financing mechanisms. Research should also be done jo assess progress towards the attainment of alternative goals of cost-sharing in health.