Category: 3-Health Systems, Non-Communicable Diseases, Public Health,

Primary and Surgical Care - Scientific Abstract

Abstract N°: 1190

‘Health Insurance Deserts’ & Disparities in Healthcare Coverage in Kenya: A Spatiotemporal Analysis of
Population Level Household Data

WERE L.1

Ma Y.1

Xin C.2

Gopal S.1

1
Boston University, Boston, MA, United States, 2University of California, Los Angeles, Los Angeles, United States

Background:

In a bid to improve access to timely & quality health services, healthcare systems have reformed their health insurance
programs to provide access to critical care and offer financial protection for the most vulnerable. Kenya, which has the
oldest national health insurance program in sub-Saharan Africa established in 1966, has recently reformed its national
health insurance program and earmarked additional resources for marginalized counties through an equalization fund.
However, it is not clear how these reforms have influenced health insurance coverage spatially and over-time or
whether insurance enrollment reflects social and structural disparities. This analysis thus evaluates health insurance
enrollment in the 47 counties in Kenya by gender and compares 13 marginalized counties to 34 non-marginalized
counties.

Methods:

Using data from the Kenya Demographic and Health Surveys (KDHS), spatial pattern analysis was used to highlight
health insurance hot spots and cold spots at the household cluster level. Health insurance enrollment centers and
offices were geocoded, and the location information used in a spatial network analysis to estimate travel times and
distances from population clusters to nearest health insurance enrollment centers. Further, an Insurability Score
ranging between 0-1 was developed to quantify ‘health insurance deserts’ and the associated disparities by accounting
for population density, travel time, gender, insurance enrollment coverage, and distribution of health insurance
enrollment centers. We thus define ‘health insurance deserts’ as clusters with an insurability score greater than 0.5 i.e.,
population clusters with lower insurance coverage.

Findings:

We find that gender difference in health insurance enrollment exist with higher health insurance rates for men
[women=7% vs men=15%]. Additionally, our analysis shows that marginalized counties are largely characterized by
insurance cold spots, longer travel times to health insurance enrollment centers, and ‘insurance deserts’. We thus
propose an additional 95 health insurance enrollment centers to mitigate the ‘health insurance desert’ effects leading to
a national average reduction in travel time to health insurance enrollment centers by 20 minutes.

Interpretation:

To reduce disparities in health insurance enrollment and coverage for marginalized communities, national and global
policies that address ‘health insurance deserts’ and associated enrollment bottlenecks are necessary and timely.

Source of Funding:

None