Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya
Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya
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DOI：
10.1186/s12939-019-1116-x
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发表时间：
2020-02-03
影响因子：
4.8
通讯作者：
Barasa, Edwine
中科院分区：
文献类型：
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作者：
Mbau, Rahab;Kabia, Evelyn;Barasa, Edwine
肯尼亚通过国家医院保险基金扩大医疗保险覆盖面，将实现全民健康覆盖作为优先事项。2015年，NHIF对保费缴纳率、福利计划和提供者支付方式进行了改革。我们研究了这些改革对NHIF采购实践的影响及其对战略采购和卫生系统公平、效率和质量目标的影响。方法以NHIF为案例，以改革为嵌入式分析单元，进行嵌入式案例研究。我们在国家一级和两个有目的地选择的县收集数据，通过与卫生筹资利益相关者、设施管理者和一线提供者进行41次深入访谈;与51名NHIF成员进行4次焦点小组讨论;以及文件审查。我们使用框架方法分析数据。结果新的NHIF改革的特点是弱购买行动。首先，新的保险费缴款率没有得到充分宣传，某些公民群体负担不起。第二，据报告，新的一揽子福利计划是根据民众的服务需求、偏好和价值观制定的，但没有得到充分宣传，而且在不同公民群体之间分配不均。此外，公共保健设施中存在服务提供基础设施缺口，以及签约保健设施的分布偏向城市和偏向私人，这些都损害了这些新服务的提供和获得。最后，新的提供者支付方法和费率被认为是不够的，付款延迟，与财务问责机制的联系薄弱，损害了他们激励公平、效率和医疗保健质量的能力。结论虽然NHIF寻求扩大人口和服务覆盖面，并减少自付费用与新的改革，改革的设计和实施的弱点限制了NHIF的采购行动，对卫生系统的公平，效率和质量的目标产生负面影响。为了加快国家在全民健康覆盖方面的进展，国家卫生保险基金以及国家和县政府的决策者应该做出深思熟虑的努力，使这种改革的设计和实施与旨在改善卫生系统目标的战略采购行动保持一致。
Background Kenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF's purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality. Methods We conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach. Results The new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery. Conclusion While NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms' design and implementation limited NHIF's purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country's progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.