Assessing National Health Insurance Fund members' level of
understanding, experiences, and factors influencing their choice of
contracted outpatient facilities in Kenya
Objective: To assess National Health Insurance Fund (NHIF)
members’ level of understanding, experiences, and factors influencing
their choice of NHIF-contracted outpatient facilities in Kenya.
Methods: 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. Results: Urban-based NHIF members had a good
understanding of the NHIF-contracted outpatient facility selection
process and the approaches for choosing and changing providers, unlike
their rural counterparts. While NHIF members were required to choose a
provider before accessing care, the number of available alternative
facilities was perceived to be inadequate. Finally, NHIF members
identified 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.
Conclusion: 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. Consequently, NHIF should
leverage the preferred factors when contracting healthcare providers.
Similarly, healthcare providers should enhance the availability of
drugs, reduce waiting times whilst improving their staff’s attitudes
which would enhance user satisfaction and the quality of care provided.