Effect Of Poverty On Healthcare Utilization, Choice Of Healthcare Providers And Health Status In Kenya

ABSTRACT The importance of good health cannot be under estimated. However, presence of high poverty rates can lead to under utilization or lack of utilization of health care thus hindering achievement of good health. Thus, poverty reduction and improvement of health care utilization are important in ensuring enjoyment of good health. Despite Kenya‟s commitment to reduce poverty and improve health status of her citizens, between 1982 and 2014, poverty remained high above 40 per cent. However, in 2015/2016, poverty was estimated to have reduced to 36.1 per cent. This was against the Millennium Development Goals target of halving poverty by 2015 and the Sustainable Development Goals target of eradicating poverty by 2030. Kenya‟s health indicators have also not been impressive. Infant mortality rate, for instance, stood at 39 deaths per 1,000 live births in 2014 against Millennium Development Goals target of 22 by 2015. Maternal mortality rate remained high at 362 deaths per 100,000 live births in 2014 against Millennium Development Goals target of 147 by 2015. The Sustainable Development Goals target is to have less than 70 deaths per 100,000 live births by 2030. This poor performance in health indicates that the country needs to address the health challenges otherwise it will miss on the development goals by 2030. Health care utilization has also been low. Household members who reported illness and never sought health care stood at 22.8 per cent in 2003, before dropping to 16.7 per cent and 12.7 per cent in 2007 and 2013, respectively. Those who fell sick and reported lack of finances as the main reason for not seeking medical attention constituted 44 per cent in 2003, 38 per cent in 2007 and 21.4 per cent in 2013. These statistics point to poor health care utilization due to poverty. The aim of this study, therefore, was to investigate the effect of poverty on healthcare utilization, choice of healthcare providers and health status in Kenya. The study employed a non-experimental cross-sectional research design. The study used the Kenya Household Health Expenditure and Utilization Survey dataset of 2013. To achieve objective one, the study used Negative Binomial Regression Model, while Multinomial probit was used to address objective two. Objective three was addressed using Ordered probit model. In all the three objectives, Two Stage Residual Inclusion and Control Function models were used to control for possible endogeneity and unobserved heterogeneity. Study findings showed that increase in wealth increases health care utilization. Further, the results revealed that as wealth increased, the probability of visiting private hospitals increased while those of visiting government, mission and other health facilities declined. The results also revealed that, those with higher wealth index were more likely to report better health status compared to those with lower wealth index. The results, therefore, indicates that increase in wealth increases healthcare utilization, motivates individuals to seek healthcare from providers considered to offer high quality health services and improves health status. Thus, although Kenya missed some health related Millennium Development Goals, if poverty is addressed, the country can do better in its efforts to achieving the Sustainable Development Goals and the country‟s development plan, Kenyan Vision 2030.