Influence of Socio-Economic Determinants on National Health Insurance Membership Retention in the Informal Sector in Homabay County, Kenya.

Abstract

The role that health insurance plays in helping low-income economies pay for healthcare is becoming increasingly apparent in today's globe. The attainment of Universal Health Coverage (UHC), an objective that wishes to guarantee that all individuals have contact to necessary healthcare services without imposing financial strain or destitution, is an exceedingly high priority for emerging nations. This study intended to investigate the influence of socioeconomic factors on the maintenance of national health insurance coverage in the unorganised sector in Homabay County, Kenya, with a particular emphasis on the income, work status, educational attainment, and health status of those working in the

x

unorganised sector. The Weberian Model of Social Stratification Expected Utility theory and Rational Choice Theory were the two primary theories examined in this study. In this examination, both qualitative and quantitative research methods was applied. A structured interview guide was used to collect most of the quantitative data using a focus group discussion technique, which was double-checked for accuracy and completeness. Information from the NHIF database was gathered at many sites using a cross-sectional survey design. The Homabay branch, Mbita station, and Oyugis station made up the target population. The correlation coefficient results (R = 0.866) revealed a strong positive correlation between the predictors (income, education, employment, health status) and the dependent variable (member retention). This suggests that as socio-economic conditions improve, retention rates may also increase. The R Square (0.750) indicated that approximately 75% of the variance in national health insurance membership retention can be explained by the four socio-economic factors. Study recommends that authorities should consider revising the NHIF contribution structure to introduce a tiered system that accounts for varying income levels, particularly in the informal sector. NHIF members should engage in community forums to discuss their experiences and challenges related to health insurance. NGOs and community-based organizations should partner with NHIF to create localized programs that build awareness and educate informal sector workers about the importance of health insurance. The study concluded that households with regular income exhibit a greater capacity and commitment to making consistent NHIF contributions. This finding highlights a critical link between financial stability and health insurance participation; members who can rely on steady income are more inclined to view NHIF as an essential safety net. The fact that a substantial portion of respondents believes that higher education correlates with self-insurance capabilities suggests a disparity in health literacy within the informal sector. Given the study indication that regular income enhances commitment to NHIF contributions, subsequent research should investigate how fluctuations in income over time affect membership retention.