Abstract
Low and middle-income countries have extended state sponsored Social Health Insurance (SHI) to people outside the formal sector to enhance access to healthcare. However, in spite of the relatively low costs of signing up and the benefits offered by SHIs, up-take rates are very low among the informal sector populations. The objective of this study was to investigate factors affecting participation of people in the informal sector in the National Hospital Insurance Fund (NHIF) scheme in Kakamega County, Kenya. This cross-sectional study was conducted in Kakamega County in Western Kenya. The study employed a mixed methods designs approach. In the first phase of the study, 400 participants were recruited using both probability and non-probability sampling methods; 400 persons engaged in informal sector activities were recruited through random sampling. In the second phase of the study, 24 key informants and 5 groups consisting of 8-12 persons were purposively selected for in-depth interviews and Focus Group Discussions respectively. The study established that people in the informal sector with higher income (> Kshs.10, 000) are more likely to enroll (odds ratio 2.21 with 95% CI: 1.07 to 4.03) compared to those with low incomes and similarly, higher level of education was significantly associated with enrolment in NHIF scheme (odds ratio 31.07 with 95% CI: 17.19 to 87.94). Rigid scheme design features create difficulties for people in informal sector to participate. In conclusion, policy decisions should focus on interventions directed at educating poor populations, people with low educational levels and those working outside formal employments on the benefits of subscribing to the NHIF scheme in Kenya. The study recommends subsidies or waivers to increase affordability of participation in the NHIF scheme, particularly for people with low monthly incomes.
Highlights
Access to healthcare is still a global problem because many people cannot afford costs of health services [1]
The study established that there is still low participation of people in the informal sector in the National Hospital Insurance Fund (NHIF) scheme. This impacts negatively on access to health care since majority have to rely on out of pocket payment for health services.The low participation of individuals in the informal sector was attributed to a number of factors, including low and non-regular incomes, insecure employment, and NHIF scheme design features including inflexible payment schedules and lack of awareness about benefits of the scheme, that are not adapted to people's needs and preferences
The study highlights some of the barriers to enrolment into the NHIF scheme
Summary
Access to healthcare (services of providing medical care) is still a global problem because many people cannot afford costs of health services [1]. Most households still rely on Out-of-Pocket payments for health care [2] Reliance on out-of pocket payments deters people from seeking health care when needed and those who do seek health care suffer the problem of financial impoverishment[3, 19]. The World Health Organization (WHO) views medical fees as a significant obstacle to healthcare coverage and utilization, and has stated that the only way to reduce reliance on direct payments is for governments to encourage social protection using risk-pooling prepayment approach [46]. With social protection schemes such as Social Health Insurance (SHI), people can access health services based on the need and not ability to pay. SHI schemes are emerging as a global solution for breaking the cycle of poverty and vulnerability to ill health [45]
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