Integration of private providers in NHIF covered out patient care : factors affecting price of care
Odero, Patricia M.
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The provision of health care to the citizens of a country presents important challenges in both, developed and developing countries. Many schemes have been proposed with the ultimate goal being ensuring equity and access to high quality health care, meaning universal coverage of the population. Since the Alma Ata Declaration in 1978 the crucial importance of primary health care is widely accepted in the fight towards reducing a population's burden of disease. This has been echoed again recently by the UN Millennium Development Coals! that deal with health care. The recent focus on both coverage and quality provision of primary health care, by Kenya's national social insurer, the National Hospital Insurance Fund (NHIF) has been taken as an occasion to have a closer look into the relevant related factors. As an example, the coverage of outpatient services by the NHIF was studied, with a particular focus on the inclusion of private providers in the provision of primary health care. The literature review showed that a variety of models of social health insurance, have been developed for Low and Middle Income countries (LMICs), where the specific successes of the Indian and Philippines concept were stressed, particularly their inclusion of private providers. The need of the population (demand) was linked with the availability of health care (supply), and the reimbursement (pricing) to private providers was analyzed in this context. With the unique characteristics of health care competition is difficult, and a series of market failures are present. These unique features include asymmetry of information, supplier induced demand, the concept of the third party payer, the often unrealised role of the government and the limited competition in health care. These important concepts have been taken into consideration in the study, as well as in the conclusions the end of the study. The findings of the data analysis and insights from additional open-ended interviews with industry experts identified factors affecting outpatient consultation for private providers in Nairobi, the willingness of these providers to be included in NHIF's outpatient scheme as well as proposed methods of payment to providers. The final conclusions of this study will be highly valuable to the decision making of industry stakeholders as they consider alternative models of payment for private providers of outpatient care as opposed to the standard rebate used currently.