These include age, marital status, gender and sex, level of education, occupation Age has been indicated as a factor in a study investigating factors influencing enrollment of people in Kupra Health Insurance Scheme in India by Bawa and Jain (2006). Another study on uptake of health insurance amongst women in Ghana by Edward (2009) also found out that more people with advanced age were enrolled. Both researches attributed uptake to maturity and understanding of health risk that comes with increased age. This conquer with the conventional theory of demand for health insurance that state that by nature people at risk are compelled to willingly make pooling of funds to avoid risk of paying large sums at once for medical bills.
Marital status as a demographic information has been implied to be a factor to uptake of health insurance scheme. In a study related to NHIF uptake, the study reported that married persons are more likely to acquire and own health insurance. (Chuma Maina, 2012 Kimani et al, 2012). Marriage is accompanied by many responsibilities and as a stage of life requires individuals to take charge of not only their health matters but also all social, economic and religious matters. The married tend to pool funds as a way of preparation for future uncertainties within the family which is not a common case with the single or persons not intending to marry. Education is a factor of employability and indicator of level of income. Highly educated individuals are more likely to purchase and uptake health insurance than the lowly educated (Osei-akoto and Adamba, 2011). Level of education determines acquired skills, knowledge and income, these are important indicators to uptake of the health insurance scheme since they depict knowledge and understanding of health risk and need for insuring health.
Kirigia et al (2005) researched about the relationship between health insurance and occupation and found out that the proportion of people who had health insurance increased with increase in household income. Occupation determines income and people of different income behave differently towards acquisition of health insurance scheme. According to Dalaba et al ( 2012) ,higher income groups has a higher enrollment which is consistent with consumer theory that implicate health insurance as a normal good with positive elasticity of demand. Perry and Rosen (2001) studied the correlation between enrolment in an insurance scheme and employment and found out that there is low enrollment of self-employed compared to the wage-earners. Occupation and employment thus stand as factors influencing utilization of health insurance.
2.3.2Awareness of NHIF benefits and utilization of health insurance Mathauer (2008) study found out that lack of knowledge of informal sector workers on NHIF enrollment options and procedures is a barrier to its uptake. NHIF has been viewed as a statutory deduction by waged contributors and has been underutilized by people in this sector. Another study by Bhageerathy et al.
, (2009) in India recommended that the national health scheme required to target socio economic status which has a significant impact on the level of awareness and attitude of respondents towards health insurance while according to Jehu- Appiah et al., (2012) policy makers should recognize household perceptions towards providers, the schemes and community attributes since these are the enablers or barriers in acquiring and remaining enrolled in an insurance scheme. A study in Ghana by Arhinful (2003) on National Hospital Insurance Fund showed that both the insured and uninsured had positive perceptions on the benefits of the scheme which included economic, psychological and social benefit of insurance.
Since the establishment of NHIF in 1966 with the objective of providing all Kenyans access to quality and affordable health care, contributions to the formal sector is compulsory but voluntary to the informal sector and retirees. From the policy reforms NHIF only covers inpatient costs at selected hospitals which are mainly government hospitals, mission hospitals and some private hospitals. For high cost private hospitals there is a daily payment for a maximum of 180 days per beneficiary per year whereby the rest is paid by the beneficiary. Apart from the beneficiary, the scheme also covers the dependents including the spouse and children under 18 years and those in college and disabled dependent. NHIF has a penalty of up to five times the premium that it imposes on the contributors who do not make their payments on time. (National Health Insurance Fund, NHIF 2014).
2.3.3 Level of premiums and collection mechanisms on utilization of health insurance Insurance schemes require stipulated payments that cater for administrative functions and claims compensation. According to Gina et al ( 2012) implementing of health insurance reforms in Africa and Asia is a challenge due to high administrative costs and resistance by people in pooling of funds for services they might not need. Challenges in revenue collections have been tackled in some countries through innovation of use of information technologies and partnerships with community groups Examples , Kenyas National Hospital Insurance Fund (NHIF) using mobile payment platform to collect premium contributions. According to Logan and William ( 2002),the factors considered in determining premiums in health insurance schemes include – expected cost of benefit packages, administrative cost, expected utilization ,market prices and affordability of the premiums to the consumers. Gina and Sapna ( 2008) recommended setting premiums taking into consideration the target populations willingness to pay and the actual cost of the proposed benefit packages.
Affordability of premium is determined by the frequency and timing of payment. According to Freeman Zang (2011) affordability of premiums is a major barrier to enrolment and utilization. In Kenya self-employed individuals are offered a monthly premium of from Kshs 320 to Kshs 500. Affiliation to NHIF is per household including children under 18 years (Nation Health Insurance Fund, NHIF 2014). Informal sector contributors in the NHIF scheme can remit their contributions individually through National bank of Kenya Cooperative Bank of Kenya, Kenya Commercial Bank and M-pesa while those in organized groups can pay through the groups registered code, on quarterly ( 3months ) ,semiannually,( 6months) or an annual basis ( 12 months ).However, late payments of contributions attract a penalty equivalent to five times of the late contributions.
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