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Transcript of Health shocks and foregone care in rural Kenya 1 Institute of Health Policy & Management, Erasmus...
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