Effect of health insurance on catastrophic health expenditure among households of people with non-communicable diseases in Busia County, Kenya

INTRODUCTION Non-communicable diseases (NCDs) are increasingly becoming important causes of illness and premature deaths globally, causing up to 41 million deaths annually, mostly occurring in Low and Middle-Income Countries. However, NCD treatment is lengthy and expensive forcing households to incur catastrophic expenditure. Thus, NCDs deepen inequality and are major drivers of unending poverty due to their lengthy treatment. Kenya successively reformed the National Health Insurance Fund to include a package that covers the plight of NCDs and transform it into a primary enabler for achieving Universal Health Coverage. This study examined whether health insurance affects catastrophic health expenditure among households of people with NCDs. METHODOLOGY A quasi-experimental design was conducted among eligible households with health insurance and those without, involving a representative sample of 350 households. Trained interviewers conducted interviews at baseline and after one year with household heads. RESULTS Households without cover spent a higher proportion of their total income (23%) on NCD care compared to households with insurance (11.7%). The mean total expenditure on NCD care for insured households was Ksh. 8,657.37 (95% CI 7,061.6 - 10,253.1) while that for non-insured was Ksh. 16,851.20 (95% CI 15,255.4 - 18,445.0), p = 0.000. Although the proportion of un-insured households that incurred catastrophic health expenditure (CHE) was higher than that of insured households, the study failed to establish that the incidence of CHE was different for non-insured and insured households (χ2= 33.89, df =1, p = 0.062). CONCLUSION NHIF cover was unable to protect Households of People with NCDs from CHE. The study recommends that NHIF's benefits package be further reformed to adequately cover all NCD's care needs. County government to strengthen the health system and boost capacity at lower levels of care to enhance NHIF coverage.