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Table 6 Capitation attributes

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

AttributeDefinitionLevelsQuotes
1. Adequacy of the payment rate to cover the cost of services.Adequacy of the capitation rate to cover the costs of the services provided to the individual/enrolee.Adequate to cover the costs.
Inadequate (Patients must co-pay)
Inadequate (Patients don’t co-pay)
“[The rate should be adequate] to cover 100%.... The patient pays nothing at all.” - HMT member 3 | public provider (County B)
“Well if the NHIF is not able to top-up for the patient, then the patients should top-up for themselves.” – Senior manager 4 | faith-based provider (County B)
“They should not pay because this patient might have paid for that insurance for ten years and he is becoming sick now. Surely, they should not pay anything else.” - HMT member 1 | public provider (County B)
2. Services coveredServices to be paid by the capitation rate.All services including complex diagnostics e.g. imaging, optical and dental services.
Consultation + laboratory tests + drugs.
Consultation + drugs
Consultation + laboratory tests.
Laboratory tests + drugs
Consultation + other diagnostics
Consultation only
“I think it should include consultation, lab work, medication, [and] something like X-ray. They should be in that capitation.” – Senior manager 2 | private provider (County B)
“At least it should cover all the out-patient services, lab, pharmacy, [and] consultation.” - Senior manager 5 | faith-based provider (County B)
3. Autonomy to use capitation funds.Freedom the health care provider has in using capitation funds.Flexible
Rigid
“I think there should be restrictions. Because, you know, money is money.” - Senior manager 5 | private provider (County B)
“To us, I think they [purchasers] could come up with a method such that I’m allowed to keep my [money]... If I collect my own user fees, let me be allowed to bank it in my own... hospital account other than bank it to the [county] revenue account.” – HMT member 2 | public provider (County B)
4. Predictability of payments in terms of timingHow predictable the timing of payments isTimely (Providers know when they will be paid).
Delays (Providers don’t know when they will be paid).
“We would prefer getting these moneys quarterly. And if the decision has been made that this money is to reach the facility quarterly, then for heaven’s sake, let it be quarterly” – HMT member 4 | public provider (County A)
5. Payment scheduleTiming of payment disbursements2 weeks
4 Weeks (Monthly)
3 months (Quarterly)
6 months (Bi-annually)
12 months (Annually)
“After every two weeks it would better.” – Senior manager 2 | private provider (County A)
“On quarterly basis, the way they [NHIF] have been doing [it]… because we make our budgets after every three months.” – HMT member 1 | public provider (County A)
6. Predictability of payments in terms of amountHow predictable the payment amounts arePredictable – (Providers know the amount to expect)
Unpredictable (Providers don’t know the amount to expect).
“I wish to know what the value is. If I sold you a car for KES 100,000 [US $ 1000], I should be getting my 100,000. I’m not expecting 150 for it. Or I am not expecting 80,000 for it. I get my money. That is what I am expecting, isn’t?” - Senior manager 4 | private provider (County B)
7. Capitation amountPayment rate per individual/enrolee per year1200 per individual per year
1500 per individual per year
2000 per individual per year
2400 per individual per year
3000 per individual per year
3600–4800 per individual per year
4000 per individual per year
5000 per individual per year
6000 per individual per year
10,000 per individual per year
80,000 per individual per year
“Capitation and what they are paying is a hundred shillings [US $1 per individual per month]. So, if you could make it three - four hundred shillings [US $ 3–4 per individual per month], that would be fine.” – Senior manger 3 |private provider (County A).
“Five thousand [US $ 50] per person per year” – Senior manager 1 | faith-based provider (County B)
“For an individual per year under capitation, if I may [mention the] rate, it is 6000 [US $60] in a year.” - Senior manager 1| faith-based provider (County A)
8. List of clients registered to a health facilityList of people/enrolees registered to a health facility under capitation paymentsList available
List not available
“So, I think the best thing is that they [NHIF] are supposed to give us… the list of the patients that we are supposed to treat and the benefits” – Senior manager 4 | private provider (County B)
“I would prefer us to know the number of clients that have been allocated this facility for outpatient.” - HMT member 1 | public provider (County A)
9. Complexity of accountability mechanismsHow complex reporting and accountability mechanisms associated with capitation are e.g. notifying the NHIF using online systems every time a patient seeks care at the facility.Simple accountability requirements
Complex/burdensome accountability requirements
“Simple… so that to enable any health care worker maybe to… sign on that [NHIF] form.” – HMT member 2 | public provider (County A)
“Yeah, they [NHIF] should be strict … If I am using an NHIF form, I should have proof that this patient is the same one who is being treated. I should confirm the ID number and the age of the patient.” - Senior manager 5 | private provider (County B)
10. Performance requirementsWhether payment mechanism is tied to performance or notPayments linked to performance
Payments not linked to performance
“It should be performance-based. If you are good, they pay us good. Isn’t it? If you’re not doing well, they can say no.” – Senior manager 3 | private provider (County B)
“Performance-based payment is also an incentive for a facility because it will give you more inspiration to work… You know even in the Bible, it’s very clear. When you are given more, even more is expected of you.” - Senior manager 2 | faith-based Facility (County A)
“Capitation cannot work with performance because not everyone will come to the hospital.”– HMT member 4 | public provider (County B)