Effectiveness Of Purchasing Mechanisms In Achieving Universal Health: A Case Of National Hospital Insurance Fund In Kenya,2010-2018.

Abstract

This study sought to understand how effective the current mechanisms used to purchase healthcare are in as far as the achievement of universal health coverage in Kenya is concerned. This was done through a case study of the National Hospital Insurance Fund between 2010 and 2018. The specific objectives of the study were to establish how efficient the mechanisms used by NHIF are in delivering quality care; to evaluate if the mechanisms promote equity and financial protection as well as determining if there are adequate mechanisms to promote transparency and accountability. NHIF staff, hospital officials and members of the public were interviewed across twenty-four branch offices. Findings reveal that the capitation and rebate mechanisms were found to promote access as well as equity of health services across populations but weak in providing quality care and offering financial protection to citizens. The fees for service and bundled mechanisms had key strengths in their ability to respond positively to customer care needs and in their ability to serve wide geographical areas as well as enabling access to quality care. However, they were only available to a small section of the population. The study also established presence of contractual arrangement between NHIF and hospitals although there was minimal enforcement. The study recommends the government repositions NHIF to be a strategic purchaser of health by increasing both the rebate and capitation rates, reviewing current benefit packages and adopting more efficient and cost-effective purchasing mechanisms that address the health needs of the population.