Socio–economic Determinants of National Health Insurance Fund Membership in the Informal Sector:a Case Study of Kitui West Sub-county, Kenya

Abstract

Most nations have failed to provide their citizens with accessible and high-quality health care. National and international treaties have been ratified with little if any success as a result of this. In Kenya, against the expectations of successive governments –KANU, NARC, Grand coalition and Jubilee - the implementation of health insurance program for the mostly poor and vulnerable populations has been challenging. Registration into the state health insurer of this population of Kenyans has been discouraging and low. This study has been motivated by the desire to establish why NHIF since opening, its doors to informal sector workers 50 years ago has not been able to make significant impact in bringing these workers on board. The objective of the study was to establish the influence of socio-economic factors on NHIF membership in the informal sector. The study narrowed on four variables i.e income level, education level, age and gender. A cross sectional study was implemented to systematically sample primary data. Structured questionnaire for the self-employed population in Kitui west sub-county were utilised. Stratified sampling was used to collect data from 100 respondents. The four wards of the sub-county were used to build strata, each ward was viewed as a stratum. The data collected was analysed using SPSS to transform it from raw to usable information with the primary goal of establishing facts and imparting knowledge. The study established that health insurance coverage varies significantly across income groups. It was found that a respondent‟s level of education was significant in influencing their decision to enrol. Age is a significant determinant of NHIF registration. However, this is confounded by other variables such as education and income which are likely to increase with age. Gender plays a role in determining NHIF membership. As is the case with age variable, this is confounded by other variables namely; Income and education. This is because men are more likely to be more educated and also have a higher income compared to women. Women are also disadvantaged by power hierarchy within the households as enrolment decisions are made by the husbands as the head of households. Overall, the study revealed that income level and education level are the major determinants of enrolling into a health insurance scheme.