Examining national health insurance fund members’ preferences and trade-offs for the attributes of contracted outpatient facilities in Kenya

A discrete choice experiment

Datos Bibliográficos

ID19590682
AutoresJacob Kazungu (0000-0002-3138-7274, Kenya Medical Research Institute), Edwine Barasa (0000-0001-5793-7177, Kenya Medical Research Institute), Justice Nonvignon (0000-0002-7484-9491, University of Ghana), Matthew Quaife (0000-0001-9291-1511, London School of Hygiene & Tropical Medicine)
EditoresKaren A Grépin (0000-0003-4368-0045)
Año2025
Volumen5
Número4
Páginase0003557
Fecha de publicación2025-04-28
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaPLOS Global Public Health (JOURNAL)
Identificadores de la revistaISSN: 2767-3375 • E-ISSN: 2767-3375
EditorialPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0003557
PMID40294105
OpenAlexW4409882502
IdiomaEN
Citas recibidas1
Referencias citadas43

Patient choice of health facilities is increasingly gaining recognition for potentially enhancing the attainment of health system goals globally. In Kenya, National Health Insurance Fund (NHIF) members are required to choose an NHIF-contracted outpatient facility before accessing care. Understanding their preferences could support resource allocation decisions, enhance the provision of patient-centered care, and deepen NHIF’s purchasing decisions. We employed a discrete choice experiment to examine NHIF members’ preferences for attributes of NHIF-contracted outpatient facilities in Kenya. We developed a d-efficient experimental design with six attributes, namely availability of drugs, distance from household to facility, waiting time at the facility until consultation, cleanliness of the facility, attitude of health worker, and cadre of health workers seen during consultation. Data were then collected from 402 NHIF members in six out of 47 counties. Choice data were analysed using panel mixed multinomial logit and latent class models. NHIF members preferred NHIF-contracted outpatient facilities that always had drugs [β=1.572], were closer to their households [β=-0.082], had shorter waiting times [β=-0.195], had respectful staff [β=1.249] and had either clinical officers [β=0.478] or medical doctors [β=1.525] for consultation. NHIF members indicated a willingness to accept travel 17.8km if drugs were always available, 17.7km to see a medical doctor for consultation, and 14.6km to see respectful health workers. Furthermore, NHIF members indicated a willingness to wait at a facility for 8.9 hours to ensure the availability of drugs, 8.8 hours to see a doctor for consultation, and 7.2 hours to see respectful health workers. Understanding NHIF member preferences and trade-offs can inform resource allocation at counties, service provision across providers, and purchasing decisions of purchasers such as the recently formed social health insurance authority in Kenya as a move towards UHC

Business · Economic growth · Economics · Family medicine · Health care · Multinomial logistic regression · Purchasing · Economic and Environmental Valuation · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Marketing