Health Insurance Plan and Utilization of Health Services: The Case of Tanykina Community Health Plan; Nandi County, Kenya

Abstract

Community Based Health Insurance mechanism of Health financing targets the informal sector and the Rural who cannot access the national social health insurance. Tanykina Community Health Plan was established to help dairy farmers in Nandi North Sub county of Nandi to access quality health services using monthly milk deductions as the premiums. Despite this financial access, there is still low health care utilization by these residences. This study aimed to evaluate the effect of the perceptions of residents and clients on the utilization of health services. A cross-sectional study was conducted on patients attending the contracted health facilities. Of the 336 respondents (84% response rate) 169(50.2%) were enrolled members of TCHP, with most of them being female (95,55%) and over 50 % having at least college level of education. The level of education was highly correlated with increased healthcare utilization (p=0.069) though this was not statistically significant. Increased level of satisfaction correlated positively with increased used of outpatient services and this was statistically significant (p=0.05). The perceived availability of information was however no statistically significantly associated with increased utilization of health services in either outpatient department (p=0.112) or inpatient department (p=0.939). The perception of increased accessed to information increased with additional age of the clients. The belief that the services offered through TCHP target the poor in the society was highly associated with increased education level of the clients (p<0.05) and the duration of membership of the clients (p<0.05). There was also a 15% increase in the outpatient services use and 19% increased likelihood to increased inpatient use with the perception that the services target the poor in the society. Almost all the respondents n=325(97%) perceived that the services of TCHP are highly acceptable. The increased level of perceived acceptance was highly associated with increased utilization of inpatient services (p=0.04). Being male increased the level of perceived acceptance by 10 % compared to the female counterparts. With regard to in-patient health services an additional increase in the level of education of the insured members and the duration of membership significantly increases the utilization of these services by 0.19 and 0.89 respectively. However, the duration of membership was statistically significant (p=0.008) in influencing the level of in-patient utilization. We recommend managers of community based health insurance to continuously evaluate the perceptions that the members have in order to improve utilization of health services.