Implementation of User Fee Policy in Psychiatric Hospitals in Kenya: A Case of Mathari National Teaching and Refferal Hospital, Nairobi

Abstract

User fees have been described globally as a catalyst in utilization of healthcare services. They have been shown to bar needy populations from seeking health care services. In sub-Saharan Africa, equity for Maternal and Child Health programs is measured by the ability to pay for services. These policies are regulated to ensure affordability yet moderated to limit misuse by the general public. In Kenya, user fees were implemented as a form of cost sharing to lessen the financial burden of health financing on Kenyan patients. This occurred in 2004. The Kenyan Ministry of Health offers a financing mechanism through risk pooling to the greatest extent possible in order to achieve universal coverage for mental health care. The use of services is based solely on need for care, with no additional tax funding or required health insurance; contributions are determined by ability to pay. Diseases such as mental health have been on the rise in Kenya due to a change in lifestyle and as a result of other emerging diseases. In Kenya, the high expense of healthcare continues to be a major obstacle to receiving timely, high-quality medical care. Despite the increase in prevalence of diseases related to mental health, the government’s user fee policy has not been able to keep up with inflation. The purpose of this study was to identify the variables affecting the application of user fee policy in Kenyan psychiatric hospitals. The study was guided by objectives that were seeking to determine the utilization of user fee policy at Mathari National Teaching and Referral Hospital; to establish how hospital policies influence user fee policy implementation at Mathari National Teaching and Referral Hospital; to establish how the waiver process influences the implementation of the user fee policy in Mathari National Teaching and Referral Hospital, and to establish how collection of patient user fees influence the implementation of the user fee policy at Mathari National Teaching and Referral hospital, Nairobi. A cross-sectional study design was used. Questionnaires were administered and the data collected from a total of 177 respondents who represented 93% of the response rate. Data collected was analyzed using SPSS version 10 and presented in tables and charts. Findings from this study established that utilization of the user fee policy at Mathari National Teaching and Referral hospital was aligned to the existing hospital policies. There was need to streamline the waiver process and continuously improve the structures that govern collection of user fees in order to achieve universal health coverage. In conclusion, this study highlights that the utilization of user fees policy as highly influenced by the asymmetric information between the health care providers and the patients. Information provided on the hospital wall charts and on the job training can foster the implementation of the user fee policy. A structured approach that involves the training and development of standard operating procedures for health care providers should be put in place. This research recommends further studies to be done to establish how the mental health act of 2023 is being implemented in referral hospitals in the country. This will guide health policy planners in determining the best way possible in developing the requisite management systems that would ensure accessibility, equity and quality mental health care. Private health care givers should also assess their utilization of their payment policies to improve performance especially in psychiatric health care.