Abstract:
Objective: To examine the levels, inequalities and factors associated with health
insurance coverage in Kenya.
Methods: We analysed secondary data from the Kenya Demographic and Health Survey
(KDHS) conducted in 2009 and 2014. We examined the level of health insurance
coverage overall, and by type, using an asset index to categorise households into five
socio-economic quintiles with quintile 5 (Q5) being the richest and quintile 1 (Q1) being
the poorest. The high-low ratio (Q5/Q1 ratio), concentration curve and concentration
index (CIX) were employed to assess inequalities in health insurance coverage, and
logistic regression to examine correlates of health insurance coverage.
Results: Overall health insurance coverage increased from 8.17% to 19.59% between
2009 and 2014. There was high inequality in overall health insurance coverage, even
though this inequality decreased between 2009 (Q5/Q1 ratio of 31.21, CIX = 0.61, 95%
CI 0.52-0.0.71) and 2014 (Q5/Q1 ratio 12.34, CIX = 0.49, 95% CI 0.45-0.52).
Individuals that were older, employed in the formal sector; married, exposed to media;
and male, belonged to a small household, had a chronic disease and belonged to rich
households, had increased odds of health insurance coverage.
Conclusion: Health insurance coverage in Kenya remains low and is characterised by
significant inequality. In a context where over 80% of the population is in the informal
sector, and close to 50% live below the national poverty line, achieving high and
equitable coverage levels with contributory and voluntary health insurance mechanism is
problematic. Kenya should consider a universal, tax-funded mechanism that ensures
revenues are equitably and efficiently collected, and everyone (including the poor and
those in the informal sector) is covered.