Self reported illnesses and treatment seeking patterns
Illnesses in the four weeks preceding the survey were reported by 16.5% and 14.7% of individuals in 2003 and 2007 respectively (Table ). Hospital admissions were reported among 1.5% of individuals in 2003 and 2.0% in 2007. Preventive care was sought by 6.5% of individuals in 2003 and 4.3% in 2007. Table shows the distribution of treatment seeking actions taken in the formal health sector. A total of 4,484 outpatient visits were made to formal health care providers in 2003 compared to 4,736 in 2007. Government health facilities accounted for 57.6% of all outpatient visits in 2003 and 74.3% in 2007. Private clinics were the second largest source of outpatient care, accounting for 21.1% of visits in 2003 and 12.1% in 2007. Inpatient care followed a similar pattern with the majority of hospitalizations occurring in government hospitals (72.4% in 2003; 67.5% in 2007).
Distribution of health care actions formal care
Distribution of outpatient and inpatient benefits by sector
The distribution of health care benefits is presented in Table . Public primary health care services (PHC) benefits showed a pro-poor distribution, with the poorest quintile receiving 25.4% share of benefits in 2003 and 25.7% in 2007. The concentration index indicates a greater pro-poor distribution in 2007 (CI = -0.148), compared to 2003 (CI = -0.105). Private not-for-profit PHC benefits showed a pro-rich distribution in 2003 (CI = 0.021) and pro-poor in 2007 (CI = -0.115). Benefits from private clinics show a pro-rich pattern in both time periods, although the pro-rich distribution was greater in 2007 than in 2003 (CI = 0.051 in 2003; 0.102 in 2007).
Distribution of health care benefits across socioeconomic groups
Hospital level out-patient (OP) and inpatient (IP) benefits in all sectors were pro-rich in 2003, but in 2007, private not-for-profit service benefits were pro-poor. The poorest quintile received 13.4% and 9.5% of public hospitals outpatient and inpatient benefits in 2003, while in the same year they received 15.6% and 19.7% of outpatient and inpatient benefits respectively from the private not-for-profit hospitals. Private for-profit sector benefits showed a wider pro-rich distribution with the richest quintile receiving 40.5% and 45.5% of outpatient and inpatient benefits in 2007.
To assess differences within the public health sector, the 2007 results were categorized into different levels of care. Results show a positive relationship between the pro-rich distribution and level of care (Figure ). The richest quintile received 63.5%, 23.5% and 26.0% share of outpatient benefits for tertiary, provincial and district level facilities respectively. In contrast, the poorest quintile received 2.5%, 4.7% and 14.8% share of tertiary, provincial and district level outpatient benefits respectively.
Distribution of public sector benefits by hospital category (2007).
Distribution of total health care benefits
When benefits for each sector are combined to arrive at an overall sector distribution, results reveal similar patterns for the public, private-not-for-profit and private-for-profit sectors in 2003; although some differences were noted in 2007 (Figures and ). Overall, in 2003, about 50% of all hospital level benefits in each sector were received by the richest two quintiles (CI = 0.105 for public facilities; 0.088 for private-not-for-profit; 0.117 for private-for-profit facilities). In 2007, this proportion reduced to 42.1% for public sector benefits and 36.8% for private-not-for-profit benefits, while it increased to 55.6% for private-for-profit benefits. When benefits for each sector are combined to arrive at total health system distribution, the results indicate that the Kenyan health system is generally pro-rich. The richest two quintiles received a 50.2% share of total health systems benefits in 2003 (CI = 0.109) and 46.7% share of total health system benefits in 2007 (CI = 0.077).
Distribution of total benefits by sector (2003).
Distribution of total benefits by sector (2007).
Distribution of government subsidy
Estimating the incidence of public health spending requires that out-of-pocket payments are subtracted from total benefits. Table shows the distribution of the subsidy derived from public health care spending and the mean per capita subsidy across socioeconomic groups. The results reveal a similar pattern as previously observed before out-of-pocket payments were subtracted from health care benefits. Public health care benefits were pro-poor in 2003 (CI = -0.098) and 2007 (CI = -0.17), although differences across socioeconomic status in 2003 were not statistically significant (p = 0.139). Hospital level subsidy was mainly pro-rich for both time periods, except the inpatient subsidy that indicated a pro-poor pattern in 2007 (CI = -0.031). Total government subsidy for all levels of care were pro-rich in 2003 (CI = 0.08; p = 0.035), but differences across socio-economic groups in 2007 were not statistically significant (CI = -0.001; p = 0.960).
Distribution of government subsidy (percentage share)
Mean per capita subsidy was higher in 2007 than in 2003 for all socioeconomic groups. In 2003, the poorest quintile received the lowest per capita subsidy of KES 125.6 but in 2007, mean per capita subsidy was lowest among the richest population (KES 170.6). Although the distribution of government subsidy was pro-rich, when the subsidy is expressed as a proportion of household total expenditure, the results indicate a progressive distribution (i.e. the poor received a subsidy that was a larger proportion of their expenditure compared to that received by the richest population).
Distribution of benefits according to need
A limitation of most BIA studies is their failure to assess the extent to which benefits are distributed according to need. Figure compares the distribution of total health system benefits with the need for care (based on SAHS). The results show that the share of self-assessed need differed significantly across socioeconomic groups (p < 0.001 in 2003; 0.08 in 2007). The poorest quintile reported the highest share of need for care in both time periods (27.1% and 21.6% in 2003 and 2007 respectively), but received the lowest share of benefits (14.6% in 2003 and 17.1% in 2003 and 2007). In contrast, the richest quintile received benefits that were significantly higher than their share of need. Differences in the share of benefits received across socio-economic groups were statistically significant (p < 0.001).
Distribution of benefits and need for care.