expansion of nhif benefits to cover outpatient...
TRANSCRIPT
Evaluating Impact:
Turning Promises into Evidence
S Munga, G Okello, L Musyoka, J Njagi, F C Marwa, R T Moore
Cape Town, South Africa
December 2009
Expansion of NHIF Benefits
to Cover Outpatient Services
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1. Background
The Health Insurance concept has been in Kenya since pre-independence (1898)
The Health Insurance Sub sector can be divided into:
Public Health Insurance (NHIF)- 5.5 Million
Private Health Insurance – 350,000
Community Based Health Insurance – 100,000
NHIF was established in 1966, became a state corporation in 1998.
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1. Background Cont’d
Who is covered? Public Servants – 880,000 Contributors Private Sector workers – 1.05 Million Contributors Informal Sector workers – 470,000 contributors Dependants – 3.1 Million Total Beneficiaries – 5.52 Million Kenyans
What is covered? The benefit package is defined in the NHIF Act as In
and out-patient covers NHIF has only been offering inpatient cover and will
be rolling out the out-patient programme to the entire country as from July 2010.
Comprehensive Inpatient cover in Public, Faith-based and Small/Medium Private facilities
Co-payment in High-cost Private Healthcare Providers
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1. Background Cont’d
How is it Rated and priced? Premiums are mandatory for the employed
workers and voluntary for the informal sector workers
Premiums range between Kshs 30 (US$.40) to Kshs 320 (US$4.25) per month for the employed workers
Kshs 160 (US$2.13) per month for the informal sector workers
Who provides Services? Accredited and contracted healthcare
providers – Public, Private and Faith-based
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1. Background Cont’d
How are they paid:
Through a mix of Fee-For-Service and capitation
Currently, Diagnostic Related Group (DRG) is on pilot for maternal health.
What might we measure?
The Impact of the Out-patient cover on Out of Pocket Expenditure
Impact on worker productivity
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2. Results Chain
Inputs Activities Outputs Outcomes Longterm
Outcomes
•Financial resources
- Kshs 25Billion
(US$ 330M)
•Experiences of
Projects from
similar projects
•Provide a comprehensive outpatient cover to all members by July 2010•Accredit and contract 3,200 Healthcare providers nationwide•Training of HCP on Quality Standards•Continuous monitoring of the implementation process as per the Kenya Quality Model•Conduct Public Information & Education Programme
Increased productivity
•Reduced of out-of-pocket from 39% to 25% of THE•Increased Benefit payout ratio from 60% to 80%
•Increased NHIF coverage from 12% to 25% •Reduced in-patient claims severity ratio from 14% to 10%•Increased utilisation of Primary health services
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3. Primary Research Questions
What is the impact of the Outpatient cover on:
Out of Pocket Expenditure
Equity to healthcare services
How will outpatient influence the Willingness To Pay
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4. Outcome Indicators
Percentage reduction of Out of Pocket Expenditure
% reduction of claims
Utilisation levels
NHIF Enrolment rate
% coverage
Cost- efficiency
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5. Identification Strategy/Method
Household survey among target groups and matched control groups
Use of employers as randomisation units
Target Group Control Group
4 Regions Same Regions (matched)
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6. Sample and data
Multistage sampling – Stratified and Randomised
Suitable sample size at 95% confidence level and a power of 80%
Data will be colected through qualitiative and quantitative tools
Secondary data – from facilities, NHIF, HMIS etc
Because the Outpatient cover will be universal and services are expected to be rendered immediately, Randomised Promotion method will be used for IE
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7. Time Frame/Work Plan
Since it will be implemented from July2010 , the activities will be:
Finalisation of the proposal – January 2010
Questionaire development & Pretesting – Feb2010
Recruitment & Training of fieldworkers &Supervisors – March 2010
Initial Data collection - April 2010
Data entry and analysis – April/ May 2010
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7. Time Frame/Work Plan Cont’d
Report Writing for Baseline survey – May/June2010
Stakeholder briefing and commissioning – June2010
Follow up survey – June 2012
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8. Sources of Financing
NHIF
GoK
World Bank