ArticlePloS one2020
Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis.Bulletin of the World Health Organization · 2022Pooled it
- Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review.PloS one · 2022Pooled it
- Betwixt playing the waiting game and waiting in vain: Temporal governance and the thin alignment of care under universal health coverage in Kenya.Medical anthropology quarterly · 2026Article
- Impact of oxidative stress on female reproductive parameters: an analysis of systemic and follicular biomarkers.JBRA assisted reproduction · 2025Article
- Barriers of access to primary healthcare services by National Health Insurance Fund capitated members in Uasin Gishu county, Kenya.BMC health services research · 2024Article
- Decomposing socioeconomic inequality in household out of pocket health expenditures in Pakistan (2010-11-2018-19).BMC health services research · 2024Article
- Socioeconomic Inequalities in Out-of-Pocket and Catastrophic Health Expenditures in Pakistan.International journal of public health · 2024Article
- Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study.BMC health services research · 2023Article
- Assessing the inequality in out-of-pocket health expenditure among the chronically and non-chronically ill in Saudi Arabia: a Blinder-Oaxaca decomposition analysis.International journal for equity in health · 2022Article
- Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature.Health research policy and systems · 2022Article
- Exploring dynamics in catastrophic health care expenditure in Nigeria.Health economics review · 2022Article
- Impact of household shocks on access to healthcare services in Kenya: a propensity score matching analysis.BMJ open · 2021Article
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Authors and funding
3 authors.
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Abstract
backgroundCatastrophic health expenditure (CHE) is frequently used as an indicator of financial protection. CHE exists when health expenditure exceeds a certain threshold of household consumption. Although CHE is reported to have declined in Kenya, it is still unacceptably high and disproportionately affects the poor. This study examines the socioeconomic factors that contribute to inequalities in CHE as well as the change in these inequalities over time in Kenya.
methodsWe used data from the Kenya household health expenditure and utilisation (KHHEUS) surveys in 2007 and 2013. The concertation index was used to measure the socioeconomic inequalities in CHE. Using the Wagstaff (2003) approach, we decomposed the concentration index of CHE to assess the relative contribution of its determinants. We applied Oaxaca-type decomposition to assess the change in CHE inequalities over time and the factors that explain it.
resultsThe findings show that while there was a decline in the incidence of CHE, inequalities in CHE increased from -0.271 to -0.376 and was disproportionately concentrated amongst the less well-off. Higher wealth quintiles and employed household heads positively contributed to the inequalities in CHE, suggesting that they disadvantaged the poor. The rise in CHE inequalities overtime was explained mainly by the changes in the elasticities of the household wealth status.
conclusionInequalities in CHE are persistent in Kenya and are largely driven by the socioeconomic status of the households. This implies that the existing financial risk protection mechanisms have not been sufficient in cushioning the most vulnerable from the financial burden of healthcare payments. Understanding the factors that sustain inequalities in CHE is, therefore, paramount in shaping pro-poor interventions that not only protect the poor from financial hardship but also reduce overall socioeconomic inequalities. This underscores the fundamental need for a multi-sectoral approach to broadly address existing socioeconomic inequalities.
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