Factors influencing voluntary national hospital insurance fund enrolment and retention: a case of Busia County

Abstract

Health insurance is an important aspect of health financing. Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over numerous persons. The low uptake of NHIF in Kenya demonstrates the need for measures and strategies that would motivate and spur change at conceptual and theoretical levels in terms of universal healthcare provision. Kenya currently lacks evidence on whether income in the informal sector which contributes to the voluntary contribution members is sustainable and predictable making it able to support the financing of universal health coverage. The study used a cross-sectional survey design to determine factors influencing voluntary National Hospital insurance Fund enrolment and retention, a case of Busia County. Its specific objectives included: to examine the influence of economic status on voluntary enrolment of individuals to the National Hospital Insurance Fund in Busia County; to establish the influence of individual awareness on voluntary enrolment of individuals to the National Hospital Insurance Fund in Busia County; to determine the influence of cultural practices on retention of individuals voluntary enrolled with the NHIF in Busia County; and to explore the influence of quality of service on retention of individuals voluntary enrolled with the NHIF in Busia County. The theoretical foundation featured the conventional health insurance theory and the expected utility theory. The study population was drawn from Busia County and was concentrated in four sub counties; Bunyala, Butula, Teso North and Matayos. The accessible population for the study was 63,458. The sample size for this study was 397 participants. The study used structured questionnaires to collect data. The collected data was analysed quantitatively using SPSS version 20 and Minitab version 20. The results of the age distribution indicated that the majority of the respondents were above the age of 51. As far as the level of education was concerned, the majority of the NHIF members had only primary level of education. An assessment of the results relating to the employment status showed that most of the NHIF members were self-employed. Finally, the vast majority of the members had 4-6 children. Neither economic status factors nor cultural practices have negatively affected individuals’ voluntary enrolment to the NHIF. However, most individuals are neither aware about the enrolment process nor the associated health benefits. The study recommended that the policy makers of the NHIF should do more in coming up with incentives to lure younger individuals to enrol with the scheme. Further, subsidies should be offered to the informal sector so as to boost the voluntary enrolment to the scheme. The NHIF should engage in more awareness campaigns to raise the level of awareness about the method of registration and the associated benefits that accrue to someone upon registration.