Innovative Healthcare Financing and Equity through Community Based Health Insurance Schemes (CBHHIS) In Kenya

Abstract

The purpose of this study was to examine innovative healthcare financing and equity through CBHIs in Kenya. Particularly, the study explored the effect of the enrolment, mix of contributions; risk pooling, strategic purchasing and the moderating effect of government stewardship on equity in healthcare in Kenyan CBHIs. Out of the 115 CBHIs that are registered with Kenya Community Based Health Financing Association, data was collected from a sample of 79 CBHIs which had complete and consistent data. Responses were sought from four members of each CBHIs management team. Data was collected by use of questionnaires and data collection sheets for secondary data. 224 usable questionnaires were collected, representing 71% percent response rate. Data was cleaned and analyzed using Excel, SPSS version 20 and SmartPLS version 3. The study used descriptive statistics, factor analysis, path analysis and multivariate regression analysis in structural modeling equation (SEM) to investigate the relationship among variables and measure the strength and direction of relationships between constructs. Empirical results revealed that there exist a positive relationship between enrolment in CBHIs and equity in healthcare in Kenya, a negative relationship between mix of contributions in CBHIs and equity in healthcare in Kenya, positive relationship between risk pooling in CBHIs and equity in healthcare in Kenya and positive relationship between strategic purchasing in CBHIs and equity in healthcare in Kenya. Government stewardship has a positive influence on the relationship between enrolment and strategic and equity in healthcare. The major conclusion drawn from the study is that CBHIs stimulates enrolment by focusing on social capital and stimulating willingness to pay in excluded segments of the population.The current mix of contributions in CBHIs does not offer an optimal mix of funds necessary for increased access to care and financial risk protection for precluded groups. The study recommends that for realization of equity goals in the healthcare in Kenya government and sectoral partners should define the place of CBHIs with the national health policy by enacting the requisite legal and regulatory framework to guide CBHIs administrative and fiscal structures. The government should also encourage the players in health financing to consolidate the pooled funds to enhance risk equalization.