Assessing the choice of National Health Insurance Fund contracted outpatient facilities in Kenya: A qualitative study
Kenya has prioritised purchasing reforms in her quest to achieve UHC 9 and has implemented several reforms through the NHIF. The NHIF is the main public purchaser in Kenya that has been chosen as the vehicle to drive the UHC agenda in Kenya. It establishes service entitlements for the beneficiaries selects and contracts providers and reimburses them for services given on behalf of the beneficiaries. 10 Several reforms have been implemented at the NHIF in a move to transform it into a strategic purchaser. For instance prior to 2015 the NHIF only covered inpatient services however following reforms to the NHIF it included outpatient cover where providers would be contracted and paid using capitation
o assess National Health Insurance Fund NHIF members level of understanding experiences and factors influencing their choice of NHIF-contracted outpatient facil-ities in Kenya
We conducted a cross-sectional qualitative study with NHIF members in two purposefully selected counties Nyeri and Makueni counties in Kenya. We collected data through 15 focus group discussions with NHIF members. Data were analysed using a framework analysis approach.
Urban-based NHIF members had a good under-standing of the NHIF-contracted outpatient facility selec-tion process and the approaches for choosing and changing providers unlike their rural counterparts. While NHIF members were required to choose a provider before access-ing care the number of available alternative facilities was perceived to be inadequate. Finally NHIF members identi-fied seven factors they considered important when choosing an NHIF-contracted outpatient provider. Of these factors the availability of drugs distance from the household to the facility and waiting time at the facility until consultation were considered the most important.
There is a need for the NHIF to prioritise awareness-raising approaches tailored to rural settings. Further there is a need for the NHIF to contract more providers to both spur competition among providers and provide alternatives for members to choose from. Besides NHIF members revealed the important factors they consider when selecting outpatient facilities.
Publication Information
Focus County(s):
Makueni County
Programme Area(s):
Public Health & Health Research Systems
Research Priority Area(s):
Disease Domain(s):
UHC Health Insurance
Document History:
Publication Date: 22.Jul.2023
Conference Title: