Highlights
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