Document Type

Article

Department

Population Health (East Africa)

Abstract

Purpose: The study identifes provision of primary healthcare services using the capitated health model as a prerequisite for promoting positive healthcare outcomes for a country’s population. However, capitated members have continued to face challenges in accessing primary healthcare services despite enrolment in the National Health Insurance Fund (NHIF). This study sought to determine if variables such as patient knowledge of the NHIF beneft package, NHIF Premium Payment processes, selecting NHIF capitated health facilities, and NHIF Communication to citizens’ infuences access to primary healthcare services. Method: A cross-sectional analytical research design was adopted. Data was collected from patients who were using NHIF cards, who were drawn from health facilities. Data was collected using a structured questionnaire where some of the questions were rated using the Likert scale to enable the generation of descriptive statistics. Data was analysed using descriptive and inferential statistics. Logistic regression was conducted to determine the relationship between the independent and the dependent variables.

Results: The study found that four independent variables (Patient knowledge of NHIF Beneft Package, NHIF Premium Payment processes, Selecting NHIF capitated Health Facility, and NHIF Communication to citizens) were signifcant predictors of access to capitated healthcare services with signifcance values of .001, .001, .001 and .001 respectively at 95% signifcance level.

Conclusions: The study found that familiarity with the NHIF beneft package signifcantly infuenced NHIF capitated members’ access to primary healthcare services in Uasin Gishu County. While most members were aware of their healthcare entitlements, there’s a need for increased awareness regarding access to surgical services and dependents’ inclusion. Facility selection also played a crucial role, infuenced by factors like freedom of choice, NHIF facility selection rules, facility appearance, and proximity to members’ homes. NHIF communication positively impacted access, with efective communication channels aiding service accessibility. Premium payment processes also signifcantly linked with service access, infuenced by factors such as payment procedures, premium awareness, payment schedules, registration waiting periods, and penalties for defaults. Overall, patient knowledge, NHIF communication, premium payment processes, and facility selection all contributed positively to NHIF capitated members’ access to primary healthcare services in Uasin Gishu County.

Publication (Name of Journal)

BMC Health Services Research

DOI

https://doi.org/10.1186/s12913-024-11282-8

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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