Utilization of health care by insured persons in eldoret municipality, Kenya
One of the agenda for health reforms in Kenya as outlined in the Health policy framework paper of 1994, is generation of increased levels of financial resources, for the provision of cost-effective services through widely accepted cost sharing and alternative health financing initiatives. The alternative financing initiatives alluded to include health insurance. Promoting health insurance in the health care market can affect both the demand and supply of health services. In this case demand for health care will increase because insurance tends to reduce the fee paid by insured persons to providers. However, the increase may also be due to the behaviour of the insured prompted by adverse selection and moral hazard. Although health insurance coverage is not wide in Kenya, there is a significant proportion of Kenyans who have drawn it from the various organizations that provide health insurance. This study investigated the socio-demographic characteristics of insured and non-insured persons and the way they utilise health care. It was carried out in Eldoret Municipality, Rift Valley Province between December 2000 and March 2001. Sampling was done in two stages. First, the estates were sampled by multistage cluster sampling method. Then the specific households were sampled by simple random sampling. Data were collected by use of a semi-structured questinnaire written in English. A total of 377 respondents aged between 18 and 70 years were interviewed. About 88% of them Were matried. There were about 47% males and 53% females. About 50% were employed and 40.2% had attained secondary school education. 54.6% of the respondents were insured. The insurance organisation with the highest membership was the NHIF (67.3 %). 58.5% of the non-insured persons Were unwilling to take health insurance cover mainly due to lack of money to pay premiums (52.1%). Nevertheless, those Who were willing and able to join could afford to pay a mean monthly premium of Kshs. 900. 64.2% of the respondents did not consult a health provider over a period of three months prior to the interview. Of those Who consulted, 60.7% Were insured. Moreover, 51% of the insured tended to seek care from Private doctor's clinics and hospitals. On the other hand, the non-insured consulted providers mainly in government or municipal health facilities. None of the insured respondents had been admitted for chronic illnesses though some of the non-insured had been hospitalised for these types of illnesses. In conclusion, the study found that insured and non-insured persons do not use health care the same way. The insured people consult providers in private health facilities but the non-insured seek care from public hospitals. Furthermore, the study found significant relationships between age, level of education, employment, income, household size, insurance status and utilisation of health care (p> 0.05). Therefore, the practice of insurance underwriting where premiums are based on these factors is recommended to continue. Health insurance organisations also need to improve their marketing strategy so that they reach the non-insured, This may be achieved by use of the Print and electronic media. Insurance agents could also be deployed at the level of the location so that they can educate people about health insurance during the chief's barazas. Community insurance schemes and Social insurance organisations should be started in the communities.