Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya.

Purity Njagi,Jelena Arsenijevic,Wim Groot,David Hotchkiss

doi:10.1371/journal.pone.0244428

Abstract

BackgroundCatastrophic health expenditure (CHE) is frequently used as an indicator of financial protection. CHE exists when health expenditure exceeds a certain threshold of household consumption. Although CHE is reported to have declined in Kenya, it is still unacceptably high and disproportionately affects the poor. This study examines the socioeconomic factors that contribute to inequalities in CHE as well as the change in these inequalities over time in Kenya.MethodsWe used data from the Kenya household health expenditure and utilisation (KHHEUS) surveys in 2007 and 2013. The concertation index was used to measure the socioeconomic inequalities in CHE. Using the Wagstaff (2003) approach, we decomposed the concentration index of CHE to assess the relative contribution of its determinants. We applied Oaxaca-type decomposition to assess the change in CHE inequalities over time and the factors that explain it.ResultsThe findings show that while there was a decline in the incidence of CHE, inequalities in CHE increased from -0.271 to -0.376 and was disproportionately concentrated amongst the less well-off. Higher wealth quintiles and employed household heads positively contributed to the inequalities in CHE, suggesting that they disadvantaged the poor. The rise in CHE inequalities overtime was explained mainly by the changes in the elasticities of the household wealth status.ConclusionInequalities in CHE are persistent in Kenya and are largely driven by the socioeconomic status of the households. This implies that the existing financial risk protection mechanisms have not been sufficient in cushioning the most vulnerable from the financial burden of healthcare payments. Understanding the factors that sustain inequalities in CHE is, therefore, paramount in shaping pro-poor interventions that not only protect the poor from financial hardship but also reduce overall socioeconomic inequalities. This underscores the fundamental need for a multi-sectoral approach to broadly address existing socioeconomic inequalities.

Highlights

Healthcare systems’ reliance on out-of-pocket (OOP) payments can impose a financial burden on households, preventing some from seeking care and turning catastrophic for those who do [1]
The findings show that while there was a decline in the incidence of Catastrophic health expenditure (CHE), inequalities in CHE increased from -0.271 to -0.376 and was disproportionately concentrated amongst the less well-off
Descriptive analysis of households experiencing catastrophic health expenditure First, we computed the incidence of CHE, which showed a decrease from 11.4% in 2007 to 6.5% in 2013 at a threshold of 40% capacity to pay (CTP)

Summary

Introduction

Healthcare systems’ reliance on out-of-pocket (OOP) payments can impose a financial burden on households, preventing some from seeking care and turning catastrophic for those who do [1]. It is estimated that by 2010, 808 million people in the world experienced catastrophic costs, and another 97 million ($1.90-a-day poverty line) were impoverished due to health care payments [2]. This is more profound in developing countries where OOP payments are a dominant feature of financing health care [3]. Catastrophic health expenditure (CHE) has been widely used as an indicator of the extent to which the health system protects households from healthcare-related financial hardship [4].

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Conclusion