Highlights
- Patient choice can enhance the attainment of health system objectives.
- Availability of drugs, distance and waiting time are the important
factors influencing NHIF members’ choice of outpatient facilities.
- NHIF should incorporate these preferences when selecting/contracting
providers
- Awareness-raising communication should be tailored to rural setting
needs.
BACKGROUND
Since the adoption of the resolution by the World Health Organization
(WHO) member states in 2005 to transform their health financing system
towards achieving universal health coverage (UHC) by 2030, countries
have been making reforms to accelerate progress towards meeting that
target 1-3. Several studies including a 2010 WHO
Report have re-emphasised the role of health financing as a central area
to leverage reforms for UHC 4-7. While health
financing reforms should ideally focus on all three health financing
functions – revenue generation, pooling and purchasing – increasing
evidence indicate that the purchasing function is often neglected8.
Kenya has prioritised purchasing reforms in her quest to achieve UHC9 and has implemented several reforms through the
National Health Insurance Fund (NHIF). The NHIF is the main public
purchaser in Kenya which 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 11-13.
Two key design features of the outpatient cover were 1) to selectively
contract facilities and capitate NHIF members to those facilities, and
2) to allow NHIF members to choose outpatient facilities of their choice
with an opportunity to change a facility once every quarter (three
months). The inclusion of these features was intended to not only drive
down the costs of care as shown in the literature from other settings14 but also encourage competition among providers
which has been shown to enhance efficiency, quality of care, equity, and
access to healthcare services 15-17.
While allowing patient choice was a key step for NHIF to implement key
strategic purchasing actions related to both providers and citizens18, no study has examined how members perceived the
available choices, their level of awareness of the process of
choosing/changing providers and the factors they value before choosing a
facility.
Against this backdrop, this study aimed to assess the NHIF members’
level of understanding and experiences with the NHIF-contracted
outpatient facility selection process as well as the factors that
influence their choice of outpatient facilities in Kenya. Findings from
this study are crucial given the ongoing reforms to transform the NHIF
into a strategic purchaser in Kenya and the dearth of patient choice
studies especially in low- and middle-income countries.
METHODS