Kazungu Jacob, Barasa Edwine, Quaife Matthew, Nonvignon Justice
Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya.
Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
BMC Health Serv Res. 2024 Dec 18;24(1):1569. doi: 10.1186/s12913-024-12021-9.
While patient choice and provider competition are predicted to influence provider behaviour for enhancing access and quality of care, evidence on provider perceptions and response to patient choice and provider competition is largely missing in low-resource settings such as Kenya. We examined provider and purchaser perceptions about whether patient choice and provider competition influenced provider behaviour and enhanced access and quality of outpatient care in Kenya.
We conducted a qualitative study to explore this across two purposefully selected counties. We conducted 15 in-depth interviews (IDIs) with health facility managers and National Health Insurance Fund (NHIF) staff across the two counties. We examined these across five areas summarised as either local market conditions or patient feedback following the Vengberg framework.
NHIF members' choice of outpatient facilities compelled private and faith-based providers to compete for members while public providers did not view choice as a way of spurring competition. Besides, all providers did not receive any information regarding the exit of NHIF members from their facilities. Providers felt that that information would be crucial for their planning, especially in enhancing service accessibility and quality of care. Most providers ensured the availability of drugs, provided a wider range of services and leveraged on marketing to attract and retain NHIF members. Finally, providers highlighted their redesign of service delivery to meet NHIF members' needs whilst enhancing the quality-of-care aspects such as waiting time and having qualified health workers.
There is a need for NHIF to share NHIF members' exit information with providers to support their service delivery arrangements in response to NHIF members' needs. Besides, this study contributes evidence on patient choice and provider competition and their influence on access and quality of care from a low-resource setting country which is crucial as NHIF transitioned to the Social Health Authority.
虽然患者选择和提供者竞争预计会影响提供者行为，以提高医疗服务的可及性和质量，但在肯尼亚等资源匮乏地区，关于提供者对患者选择和提供者竞争的看法及反应的证据基本缺失。我们研究了提供者和购买者对于患者选择和提供者竞争是否影响肯尼亚提供者行为以及提高门诊医疗服务可及性和质量的看法。
我们进行了一项定性研究，以在两个有目的地选择的县探索这一问题。我们对两个县的医疗机构管理人员和国家健康保险基金（NHIF）工作人员进行了15次深入访谈（IDI）。我们按照Vengberg框架，在总结为当地市场条件或患者反馈的五个领域对这些访谈进行了研究。
NHIF成员对门诊设施的选择迫使私立和基于信仰的提供者争夺成员，而公立提供者不认为选择是刺激竞争的一种方式。此外，所有提供者都没有收到关于NHIF成员离开其设施的任何信息。提供者认为，该信息对他们的规划至关重要，特别是在提高服务可及性和医疗质量方面。大多数提供者确保药品供应，提供更广泛的服务，并利用营销来吸引和留住NHIF成员。最后，提供者强调他们重新设计服务提供方式，以满足NHIF成员的需求，同时改善诸如等待时间和配备合格卫生工作者等医疗质量方面的问题。
NHIF需要与提供者分享NHIF成员的退出信息，以支持他们根据NHIF成员的需求进行服务提供安排。此外，本研究提供了来自资源匮乏国家关于患者选择和提供者竞争及其对医疗服务可及性和质量影响的证据，这在NHIF向社会健康管理局过渡时至关重要。
