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2013 Kenya Household Health Expenditure and Utilisation Survey MINISTRY OF HEALTH 2013 KENYA HOUSEHOLD HEALTH EXPENDITURE AND UTILISATION SURVEY December 2014 Recommended Citation: Ministry of Health, Gov ernment of Kenya. 2014. 2013 Kenya Household Health Expenditure and Utilisation Survey. Nairobi: Gov ernment of Kenya. The United States Agency for International Development (USAID), through the Health Policy Project (HPP), prov ided funding for this study. HPP also provided technical assistance in the study design, implementation, analysis, and report writing. 2013 Kenya Household Health Expenditure and Utilisation Survey DECEMBER 2014 CONTENTS Foreword ................................................................................................................................. vii Acknowledgements ............................................................................................................. viii Executive Summary................................................................................................................ ix Survey Methodology................................................................................................................ ix Key Findings ........................................................................................................................... ix Abbreviations and Acronyms ............................................................................................. xiii Chapter 1: Introduction and Methodology.......................................................................... 1 Background.............................................................................................................................. 1 Objectives of the Survey ........................................................................................................... 1 Survey Organisation ................................................................................................................. 1 Survey Methodology................................................................................................................. 2 Chapter 2: Household Socioeconomic and Demographic Characteristics ................... 6 Characteristics of the Household Population ............................................................................... 6 Chapter 3: Household Health Status and Service Utilisation Profiles .............................. 11 Households Self-Assessment of Health Status .......................................................................... 11 Utilisation of Outpatient Healthcare Services............................................................................ 12 Unmet Need for Healthcare ..................................................................................................... 27 Chapter 4: Household Health Expenditures ....................................................................... 42 Expenditure by Sex................................................................................................................. 44 Expenditure by Residence ....................................................................................................... 44 Expenditure by Age ................................................................................................................ 45 Expenditure by Levels of Education......................................................................................... 45 Expenditure by Wealth Index .................................................................................................. 46 Expenditure by Insurance Status .............................................................................................. 46 Coping Mechanisms ............................................................................................................... 47 Catastrophic Health Spending.................................................................................................. 48 Chapter 5: Health Insurance Coverage ............................................................................. 50 Background............................................................................................................................ 50 Types of Insurance Coverage................................................................................................... 50 Insurance Coverage ................................................................................................................ 50 Services Utilisation by Insured and Uninsured .......................................................................... 51 Coverage by Residence ........................................................................................................... 52 Coverage by Education, Employment, and Health Status........................................................... 53 Coverage by Wealth Index ...................................................................................................... 54 Coverage by County ............................................................................................................... 55 References.............................................................................................................................. 57 Annexes .................................................................................................................................. 58 iii LIST OF TABLES Table 1.1. Distribution of Households by Place of Residence, 2013 ................................................. 2 Table 1.2. 2013 KHHEUS Questionnaire Sections and Units Covered .............................................. 3 Table 2.1. Population Distribution by Place of Residence, Age, and Sex, 2013 ................................. 7 Table 2.2. Population Distribution by Education Level, Residence, and Sex, 2013 ............................ 8 Table 2.3. Percent Distribution of Households by Head of Household Sex, Household Size, and Residence, 2013................................................................................................... 10 Table 3.1. Trends in Self-assessment of Health Status by Sex and Residence .................................. 11 Table 3.2. Proportion of Population Reporting Illnesses in the Four Weeks Preceding Survey.......... 12 Table 3.3. Percent of Individuals Reporting Illness by Age, Sex, Wealth Quintile, and Place of Residence, 2013 ..................................................................................................... 13 Table 3.4. Reasons for Not Seeking Treatment Despite Reporting Illness ....................................... 14 Table 3.5. Total Number of Visits and Utilisation Rates ................................................................ 14 Table 3.6. Utilisation of Health Service: Time Taken to Health Facility Where Outpatient Service Was Sought, 2013 .......................................................................................... 27 Table 3.7. Total Number of Visits and Utilisation Rates ................................................................ 27 Table 3.8. Distribution of Population Reporting Illness in the Four Weeks Preceding the Survey and Percentage of Ill Persons Who Did Not Seek Treatment by Selected Characteristics, 2013 .................................................................................................. 28 Table 3.9. Percent Reporting Illness and Never Sought Care by Sex, Wealth Quintile, and Residence, 2013 ......................................................................................................... 29 Table 3.11. Summary Statistics on Admissions ............................................................................. 31 Table 3.12. Percent Distribution of Admissions by Health Facility Type/Ownership and Residence, 2013 ....................................................................................................... 36 Table 3.13. Admissions by Health Provider Type/Ownership and Wealth Index, 2013 .................... 36 Table 4.1. Trends in Out-of-pocket Expenditures .......................................................................... 42 Table 4.2. Annual Per Capita Health Spending by Type of Service and Sex, 2013........................... 44 Table 4.3. Annual Per Capita Health Spending by Type of Service and Residence, 2013 ................. 45 Table 4.4. Annual Per Capita Expenditure on Health by Households by Education Levels, 2013 .............................................................................................................. 46 Table 4.5. Incidence of Catastrophic Health Spending ................................................................... 48 Table 5.1. Insurance Coverage by Type, 2013 .............................................................................. 50 Table 5.2. Insurance Coverage by County, 2013 ........................................................................... 56 iv LIST OF FIGURES Figure 2.1. Population Distribution by Residence and Wealth Index, 2013 ....................................... 8 Figure 3.1. Distribution of Self-assessed Health Status by Wealth index, 2013................................ 12 Figure 3.2. Average Utilisation Rates and Percent of People with Some Sickness Who Did Not Seek Care ............................................................................................. 15 Figure 3.3. Outpatient Utilisation Rate: Annual Number of Visits Per Capita by Age Group ............ 16 Figure 3.4. Main Providers of Outpatient Health Services, 2013 .................................................... 17 Figure 3.5. Outpatient Health
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