Determinants of Willingness to Renew National Hospital Insurance Fund among National Scheme Members in Kajiado County, Kenya

Abstract

Under the WHO’s systems strengthening building blocks, Health financing is key to achieving universal health coverage (UHC). However, progress to achieve equity, quality and financial protection is slow especially in Africa. Kenya is rolling-out national health insurance scheme through NHIF towards achieving UHC. However, evidence shows that uptake of NHIF is low and that voluntary membership is marked by high attrition rates. This survey sought to establish the factors connected with willingness to renew the NHIF among Supa cover members in Kajiado County. The study used mixed methods cross sectional survey to establish the causal factors of willingness to renew their NHIF covers among national scheme members. Respondents were selected through purposive sampling with stratification. Quantitative data was collected through researcher-administered questionnaires rated on a 5-point Likert scale while qualitative data was collected using key informant interview (KII) guides. The study was approved by KeMU Scientific Ethical Research Committee (SERC and a research license to conduct the research was authorized by the national commission for science, technology and innovation (NACOSTI). Data was entered in Microsoft Excel 2016, exported to SPSS version 26 for analysis. Descriptive statistics were reported using median and interquartile ranges. Binary logistic regression was used to establish the significant determinants associated with the willingness to renew the insurance covers. P-values of less than 0.05 were considered statistically significant. Overall, respondents showed high willingness to renew NHIF (median 3.86, IQR 0.75). At the multivariate logistic regression, the study findings showed that controlling for all factors, marital status, household size, household income per month, awareness of NHIF fund services, service providers and adverse selection on willingness to renew were significant determinants of willingness to renew the insurance cover (p<0.05). In conclusion, the study found that the key determinants of willingness to renew NHIF among residents of this region include; awareness of NHIF services, Service provider factors and adverse selection. Others are marital status, household size and household income. NHIF should increase the community’s awareness on the health insurance risk-benefits through member education and improve access to high-grade health services in the accredited institutions to enhance renewal of cover by members.