Abstract
BackgroundThe assessment of unmet need is one way to gauge inequities in access to healthcare services. While there are multiple reasons for unmet need, financial barriers are a major reason particularly in low- and middle-income countries where healthcare systems do not offer financial protection. Moreover, accessibility and affordability are paramount in achieving universal health coverage. This study examines the extent of unmet need in Kenya due to financial barriers, the associated determinants, and the influence of regional variations.MethodsWe use data from the 2013 Kenya household health expenditure and utilization (KHHEUS) cross sectional survey. Self-reported unmet need due to lack of money and high costs of care is used to compute the outcome of interest. A multilevel regression model is employed to assess the determinants of cost-related unmet need, confounding for the effect of variations at the regional level.ResultsCost-related barriers are the main cause of unmet need for outpatient and inpatient services, with wide variations across the counties. A positive association between county poverty rates and cost-related unmet is noted. Results reveal a higher intraclass correlation coefficient (ICC) of 0.359(35.9%) for inpatient services relative to 0.091(9.1%) for outpatient services. Overall, differences between counties accounted for 9.4% (ICC ~ 0.094) of the total variance in cost-related unmet need. Factors that positively influence cost-related unmet need include older household heads, inpatient services, and urban residence. Education of household head, good self-rated health, larger household size, insured households, and higher wealth quintiles are negatively associated with cost-related unmet need.ConclusionThe findings underscore the important role of cost in enabling access to healthcare services. The county level is seen to have a significant influence on cost-related unmet need. The variations noted in cost-related unmet need across the counties signify the existence of wide disparities within and between counties. Scaling up of health financing mechanisms would fundamentally require a multi-layered approach with a focus on the relatively poor counties to address the variations in access. Further segmentation of the population for better targeting of health financing policies is paramount, to address equity in access for the most vulnerable and marginalized populations.
Highlights
Delaying or forgoing treatment may have negative effects on health status among different population groups [1]
Proportion of population with unmet need for healthcare services The analyses show that out of those who needed health care services 88.3% needed outpatient services within the last 4 weeks, whereas 11.7% needed inpatient services within the last 12 months
Our analysis show that cost-related unmet need is higher for inpatient services at 5.2% compared to the outpatient services at 2.9%
Summary
Delaying or forgoing treatment may have negative effects on health status among different population groups [1]. At least half of the world’s 7.3 billion population are reported to not receive the essential health services they need [2]. This is more profound in developing countries where many people go without health care from which they could benefit greatly [3]. The reasons for forgoing healthcare can be found in the numerous barriers that hinder access such as [4] financial, organizational, social, psychological or cultural barriers These barriers may limit use of healthcare services and impose large healthcare coverage gaps among different population groups [5]. There is a ‘subjective’ measure based on the individual’s own assessment not to have received healthcare when needed because of access barriers beyond their control [9]. This study examines the extent of unmet need in Kenya due to financial barriers, the associated determinants, and the influence of regional variations
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