Health shocks and foregone care in rural Kenya

1 Institute of Health Policy & Management, Erasmus University Rotterdam

2 Brookings Institution Washington

3 Amsterdam Institute for International Development

Igna Bonfrer1 and Emily Gustafsson – Wright2,3

Outline

• Research problem and associated research topics

• Data and context

• Results

• Implications for policy and practice

• Discussion points and further research

Research problem and topics

• Research problem:

Rural households face a range of shocks which can have large financial impact, especially when related to health.

• Research topics:- The importance of health shocks compared to other shocks- Composition of costs related to health shocks- Coping strategies- The extent of foregone care

Data

• Baseline survey among 1226 randomly selected

households, 7597 individuals (across two sites)

• Great detail on health status (objective and subjective),

health care expenditure and coping mechanisms

• Module on household shocks

• Limited information on foregone care but useful proxy

variables

Location and details case study

- Project with Health Insurance Fund and PharmAccess

- Two sites: seperate dairy farmer cooperatives

- 75% of population in dairy farming

Results (1a) Relative importance of shocks

Conflict

Jobloss

Death

Theft

Ilness or injury

Input prices

Natural

Crop

Sale prices

0 5 10 15 20 25 30 35 40

Two shocksMore than two shocksColumn4

Percentage of households facing shock

Results (1b) Relative importance of shocks

Conflict

Death

Input prices

Sale prices

Ilness or injury

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7

Average number of shocks per household

Results (2) Health care expenditure

Drugs

Inpatient care

Outpatient care

Therapeutic appliances

Health insurance premium (NHIF)

Laboratory tests

Transport

Other

Traditional medical services

Results (3) Dominant financial coping strategies

Children to relativesBorrow bank

Seek religious helpHelp from NGO

Use insuranceBorrow money lenders

OtherWork more hours

Ask relatives gifts, loanSell livestock, assets

Do nothingDissaving

0 10 20 30 40 50 60

Percentage of illness or injury affected households

Results (4a) Foregone care• Self-reported foregone care in het last year: 21%

• Self-reported versus objective hypertension in adults

Self-reported

Objective

0 5 10 15 20 25

Hypertension

Percentage of adults

Implications for policy and practice

• Illness and injury among most important threats

• Some form of protection to

– i) prevent coping strategies with long term financial

implications (selling livestock etc.) and

– ii) limit foregone care

There is considerable scope for health insurance to protect

households financially and increase access.

• Attractive borrowing options (banks)

• Chronic burden (drugs) versus “shocks”

Discussion points and further research

• Which perspective to use?

- Foregone earnings due to illness or injury

• Which funds are used for “dissaving”?

• Prior to the introduction of health insurance:

understanding the full chain of household decisions made

when facing a shock