Health Systems Management Journal

Factors Influencing Reimbursement of Hospital Financial Claims by Private Health Insurance Companies in Kenya

Fri, 05 Jul 2019 02:14:17 +0000

Introduction: Despite the positive aspect of private health insurances, a number of challenges related to claims reimbursement for services offered to the insured have been raised. According to lean Six Sigma Improvement Project conducted in 2014 in a private hospital in Nairobi, Kenya, the top seven medical insurance companies that contributed to 40% of the corporate insurance business rejected over 4% of their total claims amounting to Kenya Shillings 214million over three years between 2011 and 2013. Even when claims are not disputed, the hospital usually experience delays in reimbursement sometimes up to 45 debtor days which is above the 30 days period stated on the contractual agreement. The broad objective of this study was to find out factors influencing payment of hospital claims by private insurance companies at a tertiary private hospital in Nairobi, Kenya. Specifically, this study sort to determine how hospital related factors, private health insurance related factors and insured related factors influence reimbursement of hospital claims by the private insurance firms. Methods: This was a cross-sectional research design using a semi-structured questionnaire to collect data. Data was collected from 94 staff members who were initially stratified by job category and thereafter randomly selected within each strata. Results: Hospital related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.548, P < .001); (β₁ = .269, P < .001). Insurance related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.385, P < .001); (β₂ = .226, P < .001). Insured related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.273, P = .008); (β₃ = .245, P < .001). The value β₀was also significant meaning that even without the three variables of interest in this study a certain minimum reimbursement will always exist. Conclusion: A continuous feedback to the employees on factors that hinder timely and full reimbursement and regular training of the employees on adherence to insurance protocol and guidelines will improve reimbursement rates. This will be further enhanced by Tailor-making the billing system to meet end users’ needs and having strategies on effective dissemination of information to the health providers and the insured clients, automation of claim processes, Continuous policy education to the insured and Stakeholders relationship to be enhanced.

Status of Health workers Knowledge on Maternal and Neonatal Health related to Service Delivery in Makueni County

Benard Kasanga David, Eunice Muthoni Mwangi, Musa Oluoch — Mon, 12 Aug 2019 23:23:11 +0000

Introduction: Globally, new born mortality remains unacceptably high. Neonatal mortality accounts for 60% of infant mortality rate in Kenya. In Makueni County, 1 in 22 children does not live to his or her first birth day. This unacceptable high mortality is despite existence of cheap and tested interventions which could reduce up to 70% of current deaths. Evidence of mismanagement of clients in the County health facilities has raised concerns whether health workers attending to mothers and neonates are knowledgeable. The purpose of this study was to determine health worker knowledge on maternal and neonatal health related to service delivery in Makueni County. Specific objectives were to determine prenatal care, pre-eclampsia and postnatal care knowledge among primary care givers and how it relates to service delivery. Methods: we used a cross sectional research design. A total of 163 health workers selected through simple random sampling were involved. Data was collected using a structured questionnaire and observational checklist. Results: On prenatal care, majority of health workers (89, 54.6%) had good knowledge (x²=45.1 p<0.05). Practice didn’t conform to guidelines since 30.3% and 69.7% of antenatal mothers didn’t have full history taken and general physical examination done respectively. On pre-eclampsia, majority of caregivers (78, 49.4%) had poor knowledge while on postnatal care (53, 32.5%), (58, 37.4%) and (132, 80%) had good knowledge in new-born care, management of neonatal infections and young infant feeding respectively. Conclusions: The study concluded that health workers were not following guidelines and lacked adequate knowledge in management of pre-eclampsia, new-born care and neonatal infections. Recommendations: The study recommends the following to Makueni County health managers (i) to have refresher course, targeted continuous medical education and standard operating procedure on management of pre-eclampsia (ii) to strengthen supportive supervision and ensure guidelines are adhered to (iii) to retrain workers on new-born care and management of neonatal infections.

Factors Affecting Healthcare Waste Management System in Machakos County, Kenya

Michael Musango Mwania, Musa Oluoch, Fredrick Kimemia — Mon, 12 Aug 2019 00:00:00 +0000

Introduction:Machakos County health facilities have poor healthcare waste segregation, treatment and disposal practices; patients, health workers including waste handlers and the general population are exposed to risks of needle stick injuries and infection of HIV/AIDS and Hepatitis B&C. All population is exposed to risks associated with furans, dioxins and heavy metals released to the environment through open and crude burning of healthcare waste. World Health Organization recommends supporting and strengthening a health system based on six health system building blocks that includes quality service delivery. The study focused on strengthening the service delivery pillar of health systems in which good health services are expressed as both personal and non-personal quality care, through addressing aspects of safe healthcare waste management (HCWM) herein viewed as non-personal services that directly or indirectly affect patient, health workers and the general population health. The purpose of this study was to determine factors affecting HCWM system in Machakos County. Specific objectives were to determine the healthcare waste management process, health Managers role, human resource factors, and how healthcare waste management policy implementation affect HCWM system in health facilities in Machakos County. Methods:We used survey research design. A sample size of 120 respondents was drawn using both stratified random and purposive sampling techniques. Data was collected using questionnaires and an interview guide. Results: The findings showed that the role of health managers (β₂= .436, P< .001), human resource factors (β₃= .065, P< .002), and healthcare waste management policy implementation (β₄= .275, P< .001) influenced management of healthcare waste system. Conclusions: Health managers’ role had the strongest positive and significant influence on HCWM. Recommendations:i) adoption of safe technologies for treatment and disposal of healthcare waste, ii) refresher trainings on HCWM to all healthcare staff on existing HCWM policies in Kenya, iii) provision of adequate budget to procure enough HCWM commodities, iv) provision of adequate personal protective equipment to all health staff, and v) vaccination of health staff against Hepatitis B.

Influence of Expanded Free Maternal Care Programme on Delivery of Quality Health Care in Maternity Units in Kajiado County

Richard Wachira Magondu, Wanja Tenambergen, Fredrick Ndede — Tue, 13 Aug 2019 00:00:00 +0000

Introduction: A well-functioning health system works in harmony among the building blocks: trained and motivated health workers, functional infrastructure, consistent supply of essential medicines and technologies, health information management, and sufficient funding. Africa is uniquely affected by maternal health challenges with a maternal mortality estimated at 686/100,000 live births. Kenya has high maternal mortality estimated at 360/100,000 live births. These deaths are avoidable with proper medical intervention. This study sought to assess quality of service delivery in maternity units of health facilities currently implementing expanded free maternal care programme in Kajiado County. It was guided by one general and four specific objectives: To establish how essential drugs, medical equipment, health workers and basic amenities influence quality of service delivery in maternity units of health facilities currently implementing expanded free maternal care programme in Kajiado County. Methods:The study adopted descriptive cross sectional design of survey, with midwives, clinical officers and medical officers being the target population. Since the target population was small a census was carried out. 44 self-administered questionnaires were used; the questionnaires were pre-tested for reliability using Cronbach’s-Alpha. Descriptive and inferential statistics were used to provide population details and make inferences based on data collected. Results:68% of the health facilities surveyed were dispensaries (Level 2), 23% were Health centres (Level 3), 7% were Sub County referral hospitals (Level 4) while 2% were County referral hospital (level 5). Oxytocin injectable was partly out of stock in 64% of health facilities while Magnesium sulphate was always available in only 5% 58% of assessed health facilities had a sterile delivery set. Only 18% of respondents agreed that their facilities had adequate skill mix of health workers. None of the independent variable had coefficient > 0.05 hence no problem of multi-collinearity, the probability value, p was <0.05 indicating the model used was entirely significant. Conclusion:Results show independent variables individually and combined significantly influenced provision of quality of health care in maternity units in Kajiado County Kenya

Work -Life Balance Practices and Health Workers’ Productivity in Public Hospitals in Kenya: A Case of Mandera County

Abdikadir Khalif Ibrahim, Musa Oluoch, Maureen Adoyo — Tue, 20 Aug 2019 00:00:00 +0000

Introduction: Inadequacies of work-life balance practices in public hospitals hasresultedtohigh absenteeism and lateness, less time spent in clinical care, and increased patient waiting time in public hospitals in Mandera County, Kenya. Thisstudy was doneto establish how work-life balance practices such as flexible working options, welfare programs, talent development and leave programsinfluence health workersproductivity in public hospitals in Mandera County. Methods:The study adopted a descriptive cross-sectional design and a mixed method of both quantitative and qualitative research approaches to data collection. A total of 212 respondents among health workers were sampled from public health hospitals in Mandera County. In addition 24 Key Informants were included in the study. Data collection was done using a structured questionnaire and key informant interviews. Quantitative data was analyzed using SPSS v22 to generate descriptive information and inferential statistics. Results:Results showed that the following work-life practices influenced health workers’ productivity, 71.2% of the respondents cited flexible working options, 67.5% agreed that welfare programs, 69.8% said that talent development, and 80.1% of respondents cited leave programs. Conclusions: The study concluded that work-life balance practices should be fully implemented by management for improved productivity of health workers in public hospitals in Mandera County. Recommendation:The study recommended that, public hospitals should upgrade health workers well-being programs, improve continuous professional education, implement risk allowance and fully implement existing work life balance strategies for better health worker productivity in Mandera County.

Relationship between Structural Arrangement and Provision of Primary care Quality: A Case of Health Centers in Nakuru County, Kenya

Amos Kipngetich Kandagor, Wanja Tenambergen, Eunice Mwangi — Sun, 18 Aug 2019 00:00:00 +0000

ABSTRACT
Background: Healthcare is a fundamental need, its availability and comprehensiveness helps in making people’s life better and productive. Delivery of quality care requires an efficient system with adequate capacity of well trained and motivated health workforce, good infrastructure, good leadership and governance and effective system for financing primary care. This study aimed at finding out the relationship between structural arrangement and provision of primary care quality in Kenya and majorly focused on the public health centers in Nakuru County. Methodology: The study used census research design. A total of 102 respondents comprising 17 Clinical Officers, 52 Nurses, 11 Laboratory Technologist,11 Pharmaceutical Technologist and 10 interns. Data was collected using closed and open ended questionnaire and analyzed using SPSS version 11. Findings: Adequate infrastructure led to an increase in provision of primary care quality in health centers (r=0.453, p<0.01), while increased employee capacity improved provision of primary care quality (r=0.365, p<0.0). Sufficient fund and effective financial management improved provision primary care quality (r=0.567, p<0.01) and effective governance improved provision of primary care quality (r=0.613, p<0.01). This implies that adequate infrastructure, sufficient funds, high employee capacity and effective governance improve provision of primary care quality. Conclusion: Provision of quality primary care requires good infrastructure, effective allocation and management of finance that will promote other functions that contribute to quality service, enhanced employee capacity and good governance through transparency and accountability. Policy Implication- Health policy addressing the plight of workers, Health resources for effective delivery of health service and Quality management.

Determinants of Uptake of National Hospital Insurance Fund Primary Care Health Services by Health Facilities in Nakuru Town, Kenya

Elizabeth Wanjiku Wagura, Wanja Tenambergen, Eunice Mwangi — Fri, 16 Aug 2019 00:00:00 +0000

Introduction: There is a growing international consensus on the importance of providing social protection by governments and international bodies against extreme poverty, disease, inequality, and vulnerability that could be barriers to the achievement of the Sustainable Development Goals. Of great importance is financing of healthcare services, specifically the National Health Insurance Fund primary care. Despite the provision of accessible and adequate health services being the primary goal of financing healthcare, the uptake of the primary care services scheme among service providers is still low. This paper analysis the level of uptake of National Hospital Insurance Fund (NHIF) primary care scheme amongst service providers in Nakuru Town. Specifically: It explains the influence of knowledge of service providers about the scheme on the uptake of NHIF primary care scheme. Methods:The study adopted a cross-sectional research design targeting 120 service providers from 60 health facilities that are accredited by National Hospital Insurance Fund (NHIF) within the scope of NHIF Nakuru branch. A random sample of 96 service providers was drawn from 48 health facilities. Data was collected using a structured questionnaire and an in-depth guide. Quantitative data was analyzed using descriptive and inferential statistics with the aid of SPSS version 21.0. Results:The study findings indicated that there was a significant positive correlation between the knowledge of the service providers and uptake of the scheme. Conclusions:The study recommended need for the government and particularly the ministry of health to increase the level of knowledge and awareness among the general public about the membership and benefits of the scheme. Need for stakeholders to come up with mechanisms of addressing the various barriers affecting uptake of the scheme. A similar study be conducted in more health facilities in both rural and urban settings to relate the results of this study with all settings. Need for a study targeting the general public and other stakeholders to have a holistic understanding of the perception of all the critical stakeholders.