Determinants of utilization of national hospital insurance fund outpatient services by private university employees in Nairobi

Abstract

The NHIF is a mandatory health insurance fund covering public and private formal sector workers and their dependents as the main health insurer in Kenya. NHIF has embarked on an ambitious reform program intended to convert it to a Social Insurance Health Scheme with an aim of serving as workers’ first pillar of social insurance. The national formal scheme members are entitled to all outpatient services after selecting their preferred facilities from a list of the NHIF accredited ones. However, there are some members on the National formal scheme whose contributions are remitted to NHIF by their employer every month but do not utilize the outpatient services. This study sought to determine if the NHIF benefit package, the perceived quality of care, the NHIF communication strategy and the administrative processes influence utilization of outpatient services by the national formal scheme members in Nairobi County with a focus on private University employees. It sought to assess the reasons for none or underutilization of NHIF outpatient services. This study adopted a cross-sectional descriptive design. Multistage sampling with simple random sampling was used. Quantitative data was corrected using self-administered questionnaires and analyzed using descriptive statistics. Likert and semi-structured type of questions were used as the main tool for collecting data. SPSS version 24 was used to analysed the data. The rationale of this study was to inform top management of NHIF to undertake decisions in regards to utilization of outpatient services by NHIF members in the formal National Scheme by understanding how quality service, benefit package, NHIF communication strategy and administrative processes influence utilization of outpatient services. The study finds that respondents have and will utilize NHIF outpatient services (M=3.80, SD= 0.84). They agree with NHIF administrative processes (M=3.4, SD= 0.89) and have knowledge of NHIF benefit package (M=3.42, SD= 0.82). They disagree with quality of NHIF outpatient services (M=3.21, SD= 0.66) and NHIF communication strategy (M=2.94, SD= 0.73). The study found that knowledge of NHIF outpatient benefit package (X1; t = 1.142, p = 0.255 ˃ 0.05), perceived image of NHIF outpatient services (X2; t = 1.196, p = 0.241 ˃ 0.05) and NHIF communication strategy (X3; t = 1.196, p = 0.241 ˃ 0.05) have no influence on utilization. However, NHIF administrative processes (X4; t = 4.579, P = 0.000 ˂0.05) positively contribute to and have a significant influence on utilization of NHIF outpatient services by private university employees in Nairobi county. The study recommends that a) NHIF creates awareness on the NHIF outpatient benefit package to the members, b) NHIF should vet facilities they accredit to offer outpatient services to ensure safety of healthcare services, availability of physicians, sufficient number of health workers and a well-stocked pharmacy, c) NHIF should improve on their means and frequency of communication, feedback and complains mechanisms, engage the citizens more for improvement and ensure staff are available to respond to issues, and d) Staff in NHIF accredited facilities should be made aware of patient’s entitlement to care, ease patients identification and facility selection process. This will strengthen health systems and thus improve utilization of primary health care services.