What Drives Outpatient Care Costs in Kenya? An Analysis With Generalized Estimating Equations

Mwenda, Ngugi; Nduati, Ruth; Kosgei, Mathew; Kerich, Gregory

doi:10.3389/fpubh.2021.648465

Cited by 3 publications

(2 citation statements)

References 49 publications

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“…Even in the highest income and wealth categories, the percentages of those who reported not filling prescriptions or skipping medical visits due to healthcare procurement costs were striking and higher than noted in data from the Kenya household health expenditure survey. 49 Multiple factors may be contributing to this finding, including lack of insurance coverage for outpatient non-communicable disease medications, varying demand for healthcare services 50 and the rural population included in this analysis.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional analysis of factors associated with medication adherence in western Kenya

Gala,

Kamano,

Vazquez Sanchez

et al. 2023

BMJ Open

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ObjectivesPoor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western Kenya, with a focus on cost-related and economic wealth factors.SettingWe conducted a cross-sectional analysis of baseline data of participants enrolled in the Bridging Income Generation with Group Integrated Care study in western Kenya.ParticipantsAll participants were ≥35 years old with either diabetes or hypertension who had been prescribed medications in the past 3 months.Primary and secondary outcome measuresBaseline data included sociodemographic characteristics, wealth and economic status and medication adherence information. Predictors of medication adherence were separated into the five WHO dimensions of medication adherence: condition-related factors (comorbidities), patient-related factors (psychological factors, alcohol use), therapy-related factors (number of prescription medications), economic-related factors (monthly income, cost of transportation, monthly cost of medications) and health system-related factors (health insurance, time to travel to the health facility). A multivariable analysis, controlling for age and sex, was conducted to determine drivers of suboptimal medication adherence in each overarching category.ResultsThe analysis included 1496 participants (73.7% women) with a mean age of 60 years (range 35–97). The majority of participants had hypertension (69.2%), 8.8% had diabetes and 22.1% had both hypertension and diabetes. Suboptimal medication adherence was reported by 71.2% of participants. Economic factors were associated with medication adherence. In multivariable analysis that investigated specific subtypes of costs, transportation costs were found to be associated with worse medication adherence. In contrast, we found no evidence of association between monthly medication costs and medication adherence.ConclusionSuboptimal medication adherence is highly prevalent in Kenya, and primary-associated factors include costs, particularly indirect costs of transportation. Addressing all economic factors associated with medication adherence will be important to improve outcomes for non-communicable diseases.Trial registration numberNCT02501746.

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Section: Discussionmentioning

confidence: 99%

Cross-sectional analysis of factors associated with medication adherence in western Kenya

Gala,

Kamano,

Vazquez Sanchez

et al. 2023

BMJ Open

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“…Employer-based insurance is the next most common 2019) also found out that there are significant levels of inequality in access to health services in Kenya across the wealth quintile. Mwenda et al (2021) established that poor households pay more for health care especially for outpatient services. This is because poor households cannot pay or do not have health insurance hence more out of pocket spending.…”

Section: Direct Estimation and Type Of Insurance Per Wealth Quantilementioning

confidence: 99%

Small area estimation of health insurance coverage for Kenyan counties

Mutai

2022

AStA Wirtsch Sozialstat Arch

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Health insurance is important in disease management, access to quality health care and attaining Universal Health Care. National and regional data on health insurance coverage needed for policy making is mostly obtained from household surveys; however, estimates at lower administrative units like at the county level in Kenya are highly variable due to small sample sizes. Small area estimation combines survey and census data using a model to increases the effective sample size and therefore provides more precise estimates. In this study we estimate the health insurance coverage for Kenyan counties using a binary M‑quantile small area model for women $$(n=14{,}730)$$ ( n = 14,730 ) and men $$(n=12{,}007)$$ ( n = 12,007 ) aged 15 to 49 years old. This has the advantage that we avoid specifying the distribution of the random effects and distributional robustness is automatically achieved. The response variable is derived from the Kenya Demographic and Health Survey 2014 and auxiliary data from the Kenya Population and Housing Census 2009. We estimate the mean squared error using an analytical approach based on Taylor series linearization. The national direct health insurance coverage estimates are $$18\%$$ 18 % and $$21\%$$ 21 % for women and men respectively. With the current health insurance schemes, coverage remains low across the 47 counties. These county-level estimates are helpful in formulating decentralized policies and funding models.

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Inequality of opportunity in outpatient expenditure among the elderly with multimorbidity: evidence from China

Zhang

You

et al. 2023

Int J Equity Health

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Background Inequality of opportunity (IOp) stemming from social circumstances exists in outpatient service utilization for the multimorbid elderly in China. However, little is known regarding the magnitude of the IOp and its composition. Therefore, this study aims to measure the IOp in outpatient expenditure and provide potential pathways for policy reform by assessing the contribution of each circumstance. Methods This study included 3527 elderly aged ≥ 65 years with multimorbidity from the Chinese Longitudinal Healthy Longevity Study conducted in 2017–2018. An ordinary least squares regression model was used to analyze the circumstance-influencing factors of outpatient expenditure. The parametric approach was performed to quantify the IOp in outpatient expenditure and the Shapley value decomposition method was employed to determine the contribution of each circumstance. By extracting heterogeneity in the residual of the circumstance-dependent equation of outpatient expenditure across circumstance groups divided based on cluster analysis, we captured the effect of unobserved circumstances. Results Except for pension and distance to health facilities, all the associations between circumstance and outpatient expenditure were statistically significant. The inequality caused by circumstances accounted for 25.18% of the total inequality. The decomposition results revealed that the reimbursement rate contributed 82.92% of the IOp, followed by education duration (4.55%), household registration (3.21%), household income (3.18%), pension (1.49%), medical insurance (1.26%), physical labor (0.99%), unobserved circumstances (0.86%), distance to health facilities (0.83%) and region (0.71%). Conclusions The priority of policy enhancement is to effectively improve the outpatient reimbursement benefit for treating chronic diseases. Additional crucial actions include enhancing the health literacy of the multimorbid elderly to promote the shift from medical needs to demands and accelerating the construction of rural capacity for providing high-quality healthcare to the elderly with multimorbidity.

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What Drives Outpatient Care Costs in Kenya? An Analysis With Generalized Estimating Equations

Cited by 3 publications

References 49 publications

Cross-sectional analysis of factors associated with medication adherence in western Kenya

Cross-sectional analysis of factors associated with medication adherence in western Kenya

Small area estimation of health insurance coverage for Kenyan counties

Inequality of opportunity in outpatient expenditure among the elderly with multimorbidity: evidence from China

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