Access to Health Care: the Role of a Community Based Health Insurance in Kenya

Background: Out-of-pocket payments create financial barriers to health care access. There is an increasing interest in the role of community based health insurance schemes in improving equity and access of the poor to essential health care. The aim of this study was to assess the impact of Jamii Bora Health Insurance on access to health care among the urban poor. Methods: Data was obtained from the household health interview survey in Kibera and Mathare slums; which consisted of 420 respondents; aged 18 and above who were registered as members of Jamii Bora Trust. The members of Jamii Bora Trust were divided into two groups the insured and the non-insured. Results: In total; 17.9 respondents were hospitalized and women (19.6 respondents were hospitalized and women (19.6) were more likely to be admitted than men (14.7). Those in the poorest quintile had the highest probability of admission (18.1). Those with secondary school education; large household size; and aged 50 and above also had slightly greater probability of admission (p0.25). 86 of admissions among the insured respondents were covered JBHI and those in the poorest quintile were more likely to use the JBHI benefit. Results from the logistic regression revealed that the probability of being admitted; whether overall admission or admission covered by the JBHI benefit was determined by the presence of chronic condition (p0.01). Conclusion: Utilization and take up of the JBHI benefits was high. Overall; JBHI favoured the members in the lower income quintiles who were more likely to use health care services covered by the JBHI scheme

Social support among elderly in Khon Kean Province, Thailand.

The purpose of this research was to assess perceived social support and its factors among the elderly. The study group included 734 elders who were aged 60 years old or more, and living in eight villages in Khon Kaen Province, Thailand. A structured questionnaire was used to collect the information, and perceived social support was measured by PRQ85. This study found a high level of social support was perceived among the elderly. According to the PRQ85, the highest dimension of social support was the availability of information, emotional, and material support; while the lowest dimension was being an integral part of a group. Results from multiple regressions indicate that education level, number of close friend, knowing community health staff, working status, elderly club member, and religious activities were statistically significantly related to perceived social support. In conclusion, the elderly had a high level of social support. Close friends and community health staff are important sources of support among the elderly.

Influenza vaccination among the elderly in Bangkok.

This study aimed to determine the effectiveness of influenza vaccinations among the elderly in Bangkok in reducing influenza-like illness (ILI) and influenza-related complications. Using a non-randomized, controlled, prospective methodology, healthy, active people aged 60 years or more, living in the Bangkok Metropolitan Administration (BMA) area, were studied. The two study cohorts comprised 519 persons in the vaccinated group and 520 in the non-vaccinated group. The outcome under study was influenza-like illness (ILI), as reported by the study volunteers. The two groups were comparable for most socio-demographic characteristics, except for gender, level of education, marital status, and smoking habit. The age range was 60-88 years (mean: 68 years). Females outnumbered males in both groups, with ratio of female to male of 2.6:1 and 1.9:1 in the vaccinated and non-vaccinated groups, respectively. The top three co-morbidities among these groups were hypertension, diabetes mellitus, and heart disease, in that order. Only 1% of the volunteers reported lung disease as co-morbidity. During the 12-month study period, a total of 107 volunteers reported ILI in both groups, with 38 persons in the vaccinated group and 69 persons in the non-vaccinated group. There were 46 ILI episodes in the vaccinated group, and 86 in the non-vaccinated group, for a total of 132 episodes. The incidence rates rates of influenza in this population, therefore, were 8.9% for the vaccinated and 16.9% for the non-vaccinated groups; with a reduction in the rate of reported ILI and doctor visits of 8%. Vaccine effectiveness was rated at 47.6%, crude risk ratio at 1.9 (1.33-2.75), and adjusted risk ratio at 1.92 (95% CI: 1.25-2.95), after adjustment for gender, marital status, education, and smoking habit. No complications due to ILI were observed in this population during the study period. Hospitalizations during this period were due to non-ILI related causes, such as cancer and accident.