Determinants of the uptake of National Health Insurance Fund among patients in Meru Teaching and Referral Hospital, Kenya

Abstract

High out of pocket expenditure is a big challenge to accessing healthcare in Kenya. The low uptake of National Health Insurance Fund cover manifests, in many low income and vulnerable households, as risky behaviours such as self-medication, irrational use of over-the-counter antibiotics, use of unqualified medical practitioners as well as fundraisers and sale of family property when unforeseen ill health strikes. This study explored the determinants of the uptake of National Health Insurance Fund among patients seeking health services in Meru Teaching and Referral Hospital and specifically looked at whether accessibility, awareness, organization capacity, and availability of finances influence the uptake of National Health Insurance Fund. The study adopted a descriptive cross-sectional survey design utilizing quantitative data obtained through the administration of closed ended questionnaires with approval by the Strathmore University Institutional Scientific and Ethical Review Committee. Three hundred and seventy-six (376) patients at the Meru Teaching and Referral Hospital were issued with questionnaires out of which two hundred and seventy-nine (279) responded. Quantitative data analysis techniques using Statistical Package for Social Sciences version 27.0 were applied involving descriptive statistics (frequencies, percentages, mean and standard deviation), regression and reliability analyses using Cronbach’s alpha coefficients to measure internal consistency of underlying study constructs. Results were presented using tables. The study concluded1 that the four independent study variables all influenced the uptake of National Health Insurance Fund cover with availability of finances emerging as the most significant influence on National Health Insurance Fund uptake followed by accessibility to National Health Insurance Fund services including ease of enlisting and making premium payments, then awareness of National Health Insurance Fund services and benefits and lastly organization capacity which entailed patients’ perception of the ability of the hospital to offer quality health services. All the variables were found to be significant with p-values less than 0.05. The findings of this study provide useful insights to policymakers in Kenya including those in the Ministry of Health, the National Treasury and county governments on consumer (patient) perspectives and needs regarding uptake of health cover. Kenya can make enhanced progress towards universal health coverage if initiatives to improve household finances, ease of access to health insurance administration, awareness on benefits of health cover and perceptions on health facility ability to provide quality care are undertaken even as the government transforms the National Health Insurance Fund to the Social Health Authority.