Effect of Health Insurance on Inpatient Health Service Utilization among Households Affected by Non-Communicable Diseases in Busia County, Kenya

Abstract

Background: Non-Communicable Diseases (NCDs) are increasingly becoming important agents of illness and premature deaths globally, killing up to 41 million people annually, most of which occur in LMICs. In Kenya, major NCDs are cardio-vascular diseases, chronic respiratory diseases, _____________________________________________________________________________________________________ ++ MPH; #Ph.D; *Corresponding author: E-mail: wskkemei@gmail.com; Cite as: Kemei, Wilson, Jackline M. Nyaberi, and Simon K. Ruttoh. 2024. “Effect of Health Insurance on Inpatient Health Service Utilization Among Households Affected by Non-Communicable Diseases in Busia County, Kenya”. Asian Journal of Medicine and Health 22 (8):6-14. https://doi.org/10.9734/ajmah/2024/v22i81065. Kemei et al.; Asian J. Med. Health, vol. 22, no. 8, pp. 6-14, 2024; Article no.AJMAH.119288 cancers and diabetes. They account for 50% of all inpatient morbidities and 39% of all hospital mortalities. Patients afflicted with NCDs go through expensive treatment regiments, restraining them from utilizing available care. NCDs deepen inequality and are major drivers of unending poverty. World leaders resolved to deal with the devastating consequences of NCDs as a developmental challenge under SDGs. Kenya successively reformed its National Health Insurer to include a package that address the blight of NCDs and transform it into a primary enabler for achieving UHC. There is however, evidence suggesting that enrolment in health insurance (HI) does not necessarily guarantee inpatient utilization of NCDs care. This study examined the effect of HI on inpatient health service utilization among households with NCDs. Methods: A quasi experimental design was conducted among eligible households with HI cover and those without, involving a representative sample of 350 households. Interviewers conducted interviews at baseline and after one year among household heads. Results: Utilization of Inpatient NCDs care improved 1.256 (95% CI= 0.965-1.634), times more among insured households, (P=0.04). Conclusion: HI improves inpatient utilization of NCDs care. To accelerate progress towards UHC, national government should expand HI program to all counties, improve awareness of cover package entitlements and remove payment preconditions for inpatient procedures. County government to ensure health systems at primary level are well equipped to tackle inpatient NCDs care needs. Keywords: Health insurance; inpatient health service utilization; NCDs care. ABBREVIATIONS AMPATH : Academic Model Providing Access to Healthcare. HI : Health Insurance; JKUAT :Jomo Kenyatta University of Agriculture and Technology; LMICs : Low and Middle Income Countries; NHIF : National Health Insurance Fund; SDGs : Sustainable Development Goals; UHC : Universal Health Coverage; 1. INTRODUCTION NCDs are increasingly becoming important agents of illness and premature deaths globally, killing up to 41 million people annually, majority of which occur in LMICs [1]. In Kenya, the major NCDs are cardio-vascular diseases, diabetes, chronic respiratory diseases and cancers. These 4 major NCDs account for more than 50% of all hospital admissions and 39% of hospital deaths. It is projected that by the year 2030, NCDs related hospital mortalities will have increased to 55% [2]. Patients with NCDs go through lengthy treatment regiments with most of their drug combinations being expensive, as a result of often erratic supply of essential medicine [3,4,5]. NCDs deepen inequality and are the major drivers of poverty that is passed from generation to generation. There is also evidence suggesting that most patients with NCDs have unequal access to care including screening and treatment due to low capacity in primary health care instit