title: Catastrophic health care spending and impoverishment in Kenya.
abstract: BACKGROUND
  Many health systems in Africa are funded primarily through out-of-pocket payments. Out-of-pocket payments prevent people from seeking care, can result to catastrophic health spending and lead to impoverishment. This paper estimates the burden of out-of-pocket payments in Kenya; the incidence and intensity of catastrophic health care expenditure and the effect of health spending on national poverty estimates.
  
  
  METHODS
  Data were drawn from a nationally representative health expenditure and utilization survey (n = 8414) conducted in 2007. The survey provided detailed information on out-of-pocket payments and consumption expenditure. Standard data analytical techniques were applied to estimate the incidence and intensity of catastrophic health expenditure. Various thresholds were applied to demonstrate the sensitivity of catastrophic measures.
  
  
  RESULTS
  Each year, Kenyan households spend over a tenth of their budget on health care payments. The burden of out-of-pocket payments is highest among the poor. The poorest households spent a third of their resources on health care payments each year compared to only 8% spent by the richest households. About 1.48 million Kenyans are pushed below the national poverty line due to health care payments.
  
  
  CONCLUSIONS
  Kenyans are becoming poorer due to health care payments. The need to protect individuals from health care related impoverishment calls for urgent reforms in the Kenyan health system. An important policy question remains what health system reforms are needed in Kenya to ensure that financial risk protection for all is achieved.
authors.affiliation: Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya. jchuma@kilifi.kemri-wellcome.org
authors.forename: Jane
authors.initials: J
authors.lastname: Chuma
authors.forename: Thomas
authors.initials: T
authors.lastname: Maina
mesh_terms: D000465:Algorithms; D000553:Ambulatory Care / Q000191:economics; D002388:Catastrophic Illness / Q000191:economics* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005382:Financing, Personal / Q000191:economics*; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D011203:Poverty; D012923:Social Class