IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0244428.html

Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya

Author

Listed:
  • Purity Njagi
  • Jelena Arsenijevic
  • Wim Groot

Abstract

Background: Catastrophic 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. Methods: We 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. Results: The 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. Conclusion: Inequalities 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.

Suggested Citation

  • Purity Njagi & Jelena Arsenijevic & Wim Groot, 2020. "Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-17, December.
    • Handle: RePEc:plo:pone00:0244428
    DOI: 10.1371/journal.pone.0244428
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244428
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0244428&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0244428?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. repec:wbk:wbpubs:29042 is not listed on IDEAS
    2. Richard Mussa, 2016. "Exit from catastrophic health payments: a method and an application to Malawi," International Journal of Health Economics and Management, Springer, vol. 16(2), pages 163-174, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Al-Hanawi, Mohammed Khaled, 2021. "Decomposition of inequalities in out-of-pocket health expenditure burden in Saudi Arabia," Social Science & Medicine, Elsevier, vol. 286(C).
    2. Islam, Sohidul & Roshid, Md. Mustaqim & Chandra Bhowmik, Reday & Dhar, Bablu Kumar & Raihan, Asif & Karim, Rejaul, 2025. "Policy pathways for renewable energy, health, and sustainability in sub-saharan Africa: An empirical assessment of energy access and life expectancy," Energy Policy, Elsevier, vol. 206(C).
    3. Jöst, Prisca & Lust, Ellen, 2022. "Receiving more, expecting less? Social ties, clientelism and the poor’s expectations of future service provision," World Development, Elsevier, vol. 158(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Al-Hanawi, Mohammed Khaled, 2021. "Decomposition of inequalities in out-of-pocket health expenditure burden in Saudi Arabia," Social Science & Medicine, Elsevier, vol. 286(C).
    2. Tomson Ogwang & Germano Mwabu, 2025. "A Simple Measure of Catastrophic Health Expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 34(10), pages 1821-1831, October.
    3. Jay Dev Dubey, 2025. "Foster–Greer–Thorbecke Type Catastrophic Health Expenditure Measure: An Application to India," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 23(4), pages 1001-1032, December.
    4. Albert Opoku Frimpong & Eugenia Amporfu & Eric Arthur, 2021. "Effect of the Ghana National Health Insurance Scheme on exit time from catastrophic healthcare expenditure," African Development Review, African Development Bank, vol. 33(3), pages 492-505, September.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0244428. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.