Effect of Capitation Contracting On Effective Health Service Delivery in Kenya: Providers’ Perspective

Abstract

The purpose of the study was to investigate the effect of capitation contracting on effective health service delivery in Kenya from providers’ perspective. The specific objectives were to determine the effect of; capacity of a health facility, number of capitated members to a health facility, capitation payment, copayment for services and professional indemnity insurance cover on effective health service delivery. The moderating effect of administrative structure of the health facilities on the capitation contracting variables against effective health service delivery was also examined. The study adopted a cross-sectional research design. This design enabled the researcher to observe characteristics of the study variables at one point in time and was useful for describing relationship between them. Target population was 1152 NHIF accredited health facilities to provide primary healthcare under capitation as per the list of July 2015. These health facilities were clustered into seven geographical regions and random sampling technique used to select a sample of 297 health facilities proportionate to the number of units in each cluster. Closed-ended questionnaires were used to collect both primary and secondary data from the officers incharge of the sampled facilities through face to face interviews. A positive response of 81% was achieved. The research findings revealed that; capacity of a health facility had a positive and significant effect on quality and accessibility but a negative and significant effect on affordability on delivery of health services under capitation contracting. Among the elements that defined capacity of a health facility, professional medical personnel (clinical officers, nurses and pharmaceutical technologist), facility level 3 and 4 and the number of consulting rooms had a significant impact on delivery of effective health services under capitation contracting. The number of capitated members to a health facility had a significant effect on effective health service delivery under capitation contracting. The variables that were used to define number of capitated members to a health facility were; congestion experienced by the health facility, equity distribution of capitated members to the facilities and number on consultations by the most frequent member. The effect of these elements was negative and significant on quality of services delivered but was positive and significant on accessibility and affordability of services delivered under capitation contracting. Capitation payment was found to have a negative and significant effect on delivery of health services under capitation. Timeliness of payment was used to measure the effect of capitation payment using 1st month as the base category. Capitation payments made on 2nd Month, 3rd Month and after the quarter expired were found to have a negative and significant effect on quality and affordability of service delivery however on accessibility, the effect was negative but not statistically significant. Effect of copayment of services and professional indemnity cover were found not statistically significant in determining effective health service delivery. The moderating effect of administrative structure was negative and significant on effective health service delivery however the effect on affordability was positive and only significant when evaluated under type of ownership. Out of the elements that constituted capacityof a health facility, the study concluded that level 3 and 4 health facility were more likely to deiver quality and accessible health services under capitation contracting however, were less likely to be affordable. The study also concluded that an increase in the number of the professional medical staff and the service points increased quality and accessibility of health services delivered under capitation but reduces the affordability. Under the effect of number of capitated members to a health facility, the study concluded that high number of capitated members enhanced accessibility and affordability but compromised the quality of health services delivered under capitation contracting. The study findings revealed that delay in capitation payment had a negative impact on effectiveness hence concluded that timeliness of capitation payment would enhance quality, accessibility and affordability of services delivered under capitation contracting. Accordingly, the study recommended that NHIF should audit the capacity of a health facility before accrediting it for capitation contracting. Healthcare providers should improve their internal capacity in order to deliver effective healthcare under capitation contract. To manage the problem of congestion of patients in some facilities NHIF should distribute the members on bases of health facility’s capability taking into consideration equitable distribution. To harmonise effect of administrative structure of health facilities, the study recommended that NHIF should develop standard policies and monitoring system which all health facilities delivering healthcare under capitation contract should adhere to.