1. Health shocks and foregone care in rural Kenya 1 Institute of Health Policy & Management, Erasmus University Rotterdam 2 Brookings Institution Washington 3 Amsterdam Institute for International Development Igna Bonfrer 1 and Emily Gustafsson – Wright 2,3

2. Outline Research problem and associated research topics Data and context Results Implications for policy and practice Discussion points and further research

3. Research problem and topics Research problem: Rural households face a range of shocks which can have large financial impact, especially when related to health. Research topics: -The importance of health shocks compared to other shocks -Composition of costs related to health shocks -Coping strategies -The extent of foregone care

4. Data Baseline survey among 1226 randomly selected households, 7597 individuals (across two sites) Great detail on health status (objective and subjective), health care expenditure and coping mechanisms Module on household shocks Limited information on foregone care but useful proxy variables

5. Location and details case study -Project with Health Insurance Fund and PharmAccess -Two sites: seperate dairy farmer cooperatives -75% of population in dairy farming

6. Results (1a) Relative importance of shocks

7. Results (1b) Relative importance of shocks

8. Results (2) Health care expenditure

9. Results (3) Dominant financial coping strategies

10. Results (4a) Foregone care Self-reported foregone care in het last year: 21% Self-reported versus objective hypertension in adults

11. Implications for policy and practice Illness and injury among most important threats Some form of protection to –i) prevent coping strategies with long term financial implications (selling livestock etc.) and –ii) limit foregone care There is considerable scope for health insurance to protect households financially and increase access. Attractive borrowing options (banks) Chronic burden (drugs) versus “shocks”

12. Discussion points and further research Which perspective to use? - Foregone earnings due to illness or injury Which funds are used for “dissaving”? Prior to the introduction of health insurance: understanding the full chain of household decisions made when facing a shock