Determinants of Primary Healthcare Services Access by National Health Insurance Fund Capitated Members in Uasin Gishu County, Kenya

Abstract

The availability of primary healthcare services is critical to improving a country's health results. The capitated health model is one way to attain Universal Health Coverage (UHC) and increase access to health care services. Kenya's National Health Insurance Fund (NHIF) has adopted capitated health services to support Universal Health Coverage. Despite this, many NHIF members continue to have difficulty accessing primary healthcare services. This study objectives were to determine patient understanding of the NHIF benefit package, NHIF payment processes, healthcare service provider selection, and NHIF communication with citizens. The study primary score was to analyse the crucial of primary healthcare services access by national health insurance fund capitated members in Uasin Gishu county, Kenya. A review of the existing literature identifies several problems and limitations in the NHIF system. This survey was informed by adverse selection theory. A cross-sectional research design was used to gather quantitative data. The study looked at factors that influence access to primary healthcare services, such as affordability, availability, adequacy, and accessibility. The target population included all NHIF-registered members at public health facilities. A simple random sample method was used. Data was collected using structured questionnaires, some of which were graded on a Likert scale, allowing for the creation of descriptive statistics. SPSS version 25 was used to conduct data analysis, including descriptive and inferential statistics. To compare independent and dependent variables, bivariate analysis was used, with Chi-square tests. The study used Krejcie and Morgan's algorithm to sample 384 respondents from 1,000,000 NHIF-registered members across 90 facilities. According to the study, there was a significant correlation between each of the four distinct variables—patient comprehension of the NHIF benefit pack, NHIF premium payment procedures, NHIF capitated medical center selection, and NHIF communication with citizens—and the access to capitated health services. The four independent variables had p values less than 0.05 level of significance. These included the NHIF benefit package (p = 0.001), NHIF premium payment process (p = 0.001), health services service provider selection (p = 0.001), and NHIF communication with citizens (p = 0.001). The study model explained 45.4% of the difference in access to healthcare services and correctly identified 87.2% of those with access. The study suggested that in order to encourage and increase uptake and raise understanding of the health insurance plan for the informal sector, NHIF management in various facilities should regularly train NHIF members on their entitlements, premium payment procedures, healthcare service provider selection, and coverage penalties. They should also promote flexible M-pesa payment options, even in vernacular, to reach more people, especially in rural areas, and improve access. Additionally, streamlining NHIF processes and modernizing the physical and structural environments of healthcare institutions would promote health-seeking behavior and patient preferences