Effects of co-payments on utilization of healthcare services at a private out-patient facility: a case study of AAR healthcare Kisumu Out-patient Centre

Abstract

Rising cost of healthcare is a concern worldwide. In Kenya, this has seen insurance companies report losses despite increase in premiums. In order to control the rising costs, insurance companies have introduced co-payments on healthcare services with an aim of controlling utilization by limiting visits, costs, drugs and diagnostics. However, the effectiveness of co-payments in reducing utilization is still unclear, with some studies arguing that it has little or no effect. A retrospective cross- sectional study was carried out at AAR Healthcare Kisumu Outpatient Centre amongst AAR insurance patients seeking healthcare services at the facility. The study sought to determine if presence of a co-payment affects utilization and cost of various healthcare services. Data of approximately 3238 AAR insurance patient visits over a period of 6 months was obtained from the facility CIMS and ERPS systems. Descriptive analysis was done presenting counts (percentages), means (standard deviations) and medians (interquartile ranges (IQR)). Bivariate analysis tests for differences in the demographic and clinic costs among the co-pay groups was done using Chi square tests for categorical variables and one-way analysis of variance (ANOVA) and median tests for the continuous variables, presenting the p values. Utilisation of health services was analyzed in terms of average cost per visit, number of laboratory tests done and number of drugs issued to clients with no co- payments, those paying Ksh. 50, those paying Ksh. 200 and those paying Ksh. 500 as co-payment. The study revealed no significant effect of a co-payment on the utilisation of healthcare services. There was no significant difference in the cost of a visit based on the co-payments status. The number of medication prescribed did not depend on the co-payment status. There was no significant difference in the laboratory tests ordered between those who had co-payment and those who did not have a co-payment; however there was a significant difference in the utilisation of laboratory tests based on the amount of co-payment paid, with the patient visits with a co-payment of Ksh. 50 having significantly less laboratory tests done. The results from the study can be used to inform policy on healthcare financing.