Health Insurance Types, Out-of-Pocket Payments, Government Subsidy and Healthcare Utilization in Kenya

Purpose: The use of healthcare is a necessity for every person. As such, there is a need to ensure that such services are made available to many people, especially in a developing country like Kenya. Health insurance provides added ease in how individuals access treatment and other continued care, as it eases the financial burden associated with treatment and care. This study investigates how health insurance types, out-of-pocket expenses, and government subsidy affects Kenyans’ patterns of healthcare service utilization. Methodology: This study is grounded in the Consumer Theory of Demand for Health Insurance, Grossman’s theory of healthcare utilization, and the Behavioral Models of Health Care Utilization. To achieve this, the study employed multinomial logistic regression and binary logistic regression to analyze outpatient utilization and inpatient care utilization, respectively. Findings: The key findings of the study affirm that NHIF had a positive and significant effect on health utilization; however, low enrolment, coverage, and attrition rates were also confirmed. Private and other forms of insurance had no significant effect on health utilization. Additionally, findings reveal that households suffering from chronic disease or those exposed to recurrent illnesses and lack health insurance coverage incur frequent out-of-pocket payments (OPP) to access medical care services. Lastly, findings revealed that social assistance by the government had a weak effect on the chances of visiting hospitals or other healthcare facilities for households seeking outpatient and inpatient health services. Unique Contribution to Theory, Practice and Policy: The study recommended the enactment of policies that prioritize the expansion of public health insurance coverage. Additionally, public insurance schemes should formulate and implement policies that enhance targeted interventions by introducing specialized packages that address different health care needs and the burden of diseases. Lastly, the government should review health subsidization policies and introduce strategies that can enhance the identification and subsidization of the less privileged but disease-burdened households, particularly in rural areas and marginalized communities.