Characteristics and Effects of Multiple and Mixed Funding Flows to Public Healthcare Facilities on Financing Outcomes: A Case Study From Nigeria

Onwujekwe, Obinna; Mbachu, Chinyere; Ezenwaka, Uchenna; Arize, Ifeyinwa; Ezumah, Nkoli

doi:10.3389/fpubh.2019.00403

Cited by 13 publications

(9 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Existing evidence from a purchasing study in Kenya revealed that the differences (such as predictability and sufficiency) in the multiple funding flows to public health facilities lead to undesired provider behaviour such as inequitable prioritisation of resources and services in favour of patients from schemes with higher payment rates 33 . Similar findings have been reported from studies in Nigeria 34 . It is essential to consider the economic signals that different provider payment mechanisms have on provider behaviour to both develop and implement coherent provider payment mechanisms that elicit the required incentives for meeting the health system goals [35][36][37] .…”

Section: Discussionsupporting

confidence: 92%

Assessing the progress and gaps in strategic health purchasing in Kenya

Kazungu

Kabia

Munge³

et al. 2021

Wellcome Open Res

View full text Add to dashboard Cite

Background: Kenya has committed to achieve universal health coverage (UHC) and prioritised purchasing reforms. Existing evidence indicates that purchasing can be leveraged to achieve health system objectives when done strategically. However, no single study has collated evidence on the progress and bottlenecks on strategic health purchasing (SHP) in Kenya to inform requisite SHP reforms in moving towards UHC. Against this backdrop, we assessed the progress and gaps in SHP in Kenya. Methods: We used a cross-sectional qualitative study design and collected data using document reviews, key informant interviews, and a stakeholder engagement workshop focussing on the three main purchasers in Kenya: the National Hospital Insurance Fund (NHIF), county departments of health (CDOH) and the Ministry of Health (purchaser for vertical programmes). Data was analysed following a framework analysis approach. Results: Kenya is making progress towards developing, implementing and institutionalising SHP practices that should lead to the attainment of health system goals. Progress has been made in 1) strengthening the process of defining a health benefits package available for the population, 2) engaging in selective contracting and integrated care contracting, 3) implementing multiple provider payment mechanisms, 4) designing legal and regulatory frameworks that provide direction for purchasing, and 5) increasingly utilising information systems. However, several gaps remain. First, there remain inadequate linkages between MOH policies and the NHIF that can facilitate adequate stewardship/oversight. Second, the purchasers lack adequate capacity to ensure quality assurance and enforce contracts. Third, provider payment methods (PPM) remain poorly designed, implemented, and are not adequately linked to health system goals. Finally, purchasers have weak or unclearly defined communications strategies to patients and providers. Conclusions: Although Kenya is making progress in SHP, key gaps remain. Consequently, there is a need to implement reforms that will align the purchasers’ actions and decisions to the ideals of strategic health purchasing.

show abstract

Section: Discussionsupporting

confidence: 92%

Assessing the progress and gaps in strategic health purchasing in Kenya

Kazungu

Kabia

Munge³

et al. 2021

Wellcome Open Res

View full text Add to dashboard Cite

show abstract

“…To derive an initial list of attributes and levels, a literature review and a qualitative study were conducted. These were guided by a framework developed by the Resilient and Responsive Health Systems (RESYST) consortium on the characteristics of multiple funding flows to health facilities (Table 1) [32]. Using both a literature review and a qualitative study is recommended as the former generates conceptual attributes while the latter unearths context-specific characteristics [11, 14].…”

Section: Methodsmentioning

confidence: 99%

“…The performance requirements of the PPMWhether the PPM is tied to performancePayments tied to performancePayments not tied to performance 7. Flexibility or autonomy of the PPMAutonomy health care providers have to spend or use the PPM funds on anythingAutonomous (Flexible)Restricted (Rigid)Adapted from RESYST consortium’s framework on the characteristics of multiple funding flows [32]…”

Section: Methodsmentioning

confidence: 99%

Attribute development and level selection for a discrete choice experiment to elicit the preferences of health care providers for capitation payment mechanism in Kenya

et al. 2019

View full text Add to dashboard Cite

BackgroundStated preference elicitation methods such as discrete choice experiments (DCEs) are now widely used in the health domain. However, the “quality” of health-related DCEs has come under criticism due to the lack of rigour in conducting and reporting some aspects of the design process such as attribute and level development. Superficially selecting attributes and levels and vaguely reporting the process might result in misspecification of attributes which may, in turn, bias the study and misinform policy. To address these concerns, we meticulously conducted and report our systematic attribute development and level selection process for a DCE to elicit the preferences of health care providers for the attributes of a capitation payment mechanism in Kenya.MethodologyWe used a four-stage process proposed by Helter and Boehler to conduct and report the attribute development and level selection process. The process entailed raw data collection, data reduction, removing inappropriate attributes, and wording of attributes. Raw data was collected through a literature review and a qualitative study. Data was reduced to a long list of attributes which were then screened for appropriateness by a panel of experts. The resulting attributes and levels were worded and pretested in a pilot study. Revisions were made and a final list of attributes and levels decided.ResultsThe literature review unearthed seven attributes of provider payment mechanisms while the qualitative study uncovered 10 capitation attributes. Then, inappropriate attributes were removed using criteria such as salience, correlation, plausibility, and capability of being traded. The resulting five attributes were worded appropriately and pretested in a pilot study with 31 respondents. The pilot study results were used to make revisions. Finally, four attributes were established for the DCE, namely, payment schedule, timeliness of payments, capitation rate per individual per year, and services to be paid by the capitation rate.ConclusionBy rigorously conducting and reporting the process of attribute development and level selection of our DCE,we improved transparency and helped researchers judge the quality.

show abstract

“…Providers are incentivized to shift clients, services and/or resources from less profitable to more profitable payment mechanisms [ 30 – 32 ]. FFS reimbursements incentivize providers to increase the number of services delivered, above what is medically necessary while per-diem could incentivize providers to raise the number of hospital admissions (including unnecessary admissions) and increase the length of hospital stay for in-patients [ 31 , 33 ]. These behaviors result in cost escalation and resource wastage that jeopardize potentials for SHP to contribute to efficient utilization of limited resources to provide quality health services for those in need.…”

Section: Discussionmentioning

confidence: 99%

Supporting strategic health purchasing: a case study of annual health budgets from general tax revenue and social health insurance in Abia state, Nigeria

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Tracking general trends in strategic purchasing of health financing mechanisms will highlight where country demands may exist for technical support and where progress in being made that offer opportunities for regional learning. Health services in Abia State, Nigeria are funded from general tax-revenues (GTR), and a new state social health insurance scheme (SSHIS) is proposed to overcome the failings of the GTR and expand coverage of services. This study examined purchasing functions within the GTR and the proposed SSHIS to determine if the failings in GTR have been overcome, identify factors that shape health purchasing at sub-national levels, and provide lessons for other states in Nigeria pursuing a similar intervention. Methods Data was collected through document review and key informant interviews. Government documents were retrieved electronically from the websites of different organizations. Hard copies of paper-only files were retrieved from relevant government agencies and departments. Interviews were conducted with seven key personnel of the State Ministry of Health and State Health Insurance Agency. Thematic analysis of data was based on a strategic health purchasing progress tracking framework which delves into the governance arrangements and information architecture needed for purchasing to work well; and the core purchasing decisions of what to buy; who to buy from; and how to buy. Results There are differences in the purchasing arrangements of the two schemes. Purchaser-provider split does not exist for the GTR, unlike in the proposed SSHIS. There are no data systems for monitoring provider performance in the GTR-funded system, unlike in the SSHIS. Whereas GTR is based on a historical budgeting system, the SSHIS proposes to use a defined benefit package, which ensures value-for-money, as the basis for resource allocation. The GTR lacks private sector engagement, provider accreditation and contracting arrangements while the SSHIS will accredit and engage private providers through selective contracting. Likewise, provider payment is not linked to performance or adherence to established standards in the GTR, whereas provider payment will be linked to performance in the SSHIS. Conclusions The State Social Health Insurance has been designed to overcome many of the limitations of the budgetary allocation to health. This study provides insights into the enabling and constraining factors that can be used to develop interventions intended to strengthen the strategic health purchasing in the study area, and lessons for the other Nigeria states with similar characteristics and approaches.

show abstract

Characteristics and Effects of Multiple and Mixed Funding Flows to Public Healthcare Facilities on Financing Outcomes: A Case Study From Nigeria

Cited by 13 publications

References 15 publications

Assessing the progress and gaps in strategic health purchasing in Kenya

Assessing the progress and gaps in strategic health purchasing in Kenya

Attribute development and level selection for a discrete choice experiment to elicit the preferences of health care providers for capitation payment mechanism in Kenya

Supporting strategic health purchasing: a case study of annual health budgets from general tax revenue and social health insurance in Abia state, Nigeria

Contact Info

Product

Resources

About