Grace Litali, Peter Bukhala, Gordon Nguka


Introduction: Strategies for access and utilization of health care by all its citizens to ensure equity and equality in terms of quality health services is an important factor for governments to consider. The three basic goals of a country’s health care system are illness prevention, treating the sick and protecting people from financial catastrophes that come with medical bills. Despite this, the threat that out-of-pocket (OOP) expenditures pose to households’ living standards is increasingly recognized as a major consideration in financing health care Objective: The objective of the study was to determine the percentage contribution made by out of pocket expenditure on health care from the total household income of health care consumers in Kakamega County and also establish the association between out of pocket expenditure and insurance premium payments in Kakamega County. Design: The study design was a descriptive cross-sectional survey that utilized both quantitative methods. Setting: The study was carried out in Kakamega County Sample: A simple random sampling was applied to get participants (n = 348) Analysis: Data were analyzed through descriptive statistics, chi-square test of independence and logistic regression. Main outcome measures: Household income, expenditure on health and health insurance Results: Bivariate analysis on respondents’ factors that are associated with household income showed that there was a borderline significant relationship between the level of education and household income in the study area (OR: 0.8; 95% CI: 0.6 – 1.2; p=0.02.Out of the 348 participants, 56.6%(n=197) of the respondents reported earning directly from business proceeds from their farm, as their key source of income,14.7%(n=51) reported to get income from a relative, while 11.5%(n=40) earned directly from employment. 53.2%(n=185) reported that they spent between 1000ksh-5000ksh on food monthly. 45.1%(n=157) reported that they spent between 5000ksh-10000ksh on rent monthly. 65.8%(n=229) of the respondents reported spending between 1000-5000ksh on relatives’ medical expense in a month.62.4%(n=217) reported to spend 10000-50000ksh on inpatient healthcare in a month while. Bivariate analysis on health expenditures that are associated with household income showed that there was a borderline significant relationship between the health expenditure on relatives’ medical expense and household income (OR: 1.2; 95% CI: 0.8 – 1.4; p=0.01). 84.5%(n=294) said they were aware of insurance premiums. 37.4% of the respondents said they heard about insurance from radios. 65.5%(n=228) reported to have a family member on health insurance premiums. The findings showed that there was a significant association between out of pocket expenditure on relatives’ medical expenses and ownership of health insurance χ2(df=3) =9.112, p=0.028. Conclusion: Increased priority needs to be given to health, especially low-income countries which are in most need for additional spending on health.


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access to primary health care, direct cost, Kenya, health equity, health financing reform, health insurance coverage, low-income countries, outpatient care/cost of ambulatory care, out-of-pocket expenditure for health, sustainable health system

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