Effect of Health Insurance on Quality of care among households affected by Non-communicable diseases in Busia County, Kenya.

Abstract

Abstract- Non-Communicable Diseases (NCDs) are increasingly becoming important agents of illness and death worldwide. With the rising burden of NCDs in LMICs, Universal health coverage (UHC) has emerged as a priority intervention central to improving access to quality essential health services without suffering financial hardships among households and communities. NCDs deepen inequality and are the major drivers of poverty that is passed from generation to generation. World leaders agreed to deal with the devastating consequences of NCDs as a developmental challenge under the 2030 Sustainable Development Goals. Kenya successively reformed NHIF to include a comprehensive set of services that address the blight of NCDs and transform it as the primary enabler for achieving UHC. In spite of high quality of care being an overarching goal for performance of health systems and critical to achievement of UHC, current evidence suggests that quality of care is suboptimal particularly for people affected by NCDs. This study sought to examine the effect of HI on Perceived quality of care among households of people with NCDs in Busia County. Methods. A quasi experimental – (Pretest- posttest Non-equivalent control group) design using Propensity Score Matching method was conducted among eligible households with HI cover (intervention group) and those without (comparison group), involving a total representative sample of 350 households. Interviewers conducted face-to-face interviews at baseline and after one year among household heads. Ethical approval was obtained from Moi University Institutional Research and Ethics Committee. Results. Insured households reported a slightly higher level of overall satisfaction; however the difference was not significant. Adjusted mean gap score for insured households was -0.522 (SE 0.013), 95% CI (-0.547 to -0.496) while that for uninsured was -0.588(SE 0.013), 95% CI (-0.613 to -0.563), p value = 0.062. Insured households expressed a higher level of satisfaction with Tangibles and Assurance dimensions. Conclusion. The National government should ring fence funding for Primary health care facilities so as to improve efficiency and health system performance. County government to ensure availability of NCDs care commodities, train more care givers on NCDs management to match the rising demand and prioritize mentorship of health care providers in key areas of quality care. This will improve efficiency, build patients confidence and thus improve quality of care