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Table 7 Expert panel’s comments and decisions on capitation attributes and levels

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

Initial attribute nameInitial levelsComments by expertsNew attribute nameNew levels
1. Adequacy of the payment rate to cover the cost of servicesAdequate to cover the costs.
Inadequate (Patients must co-pay)
Inadequate (Patients don’t co-pay)
The attribute was highly correlated with the ‘capitation amount’ attribute. Therefore, the attribute was droppedAttribute dropped due to inter-attribute correlation
2. Capitation amount1200 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
The attribute name was retained as it was salient and would enable calculation of marginal willingness to accept estimates
The levels were reduced to four. The currency was in Kenya shillings. The base level was set to “1200” which reflected the current capitation rate per individual per year. Then, to get the other levels 1200 was added to the levels i.e. 1200 + 1200 = 2400. 2400 + 1200 = 3600. 3600 + 1200 = 4800. The levels were plausible and capable of being traded
Capitation amount1200 per individual per year
2400 per individual per year
3600 per individual per year
4800 per individual per year
3. Services coveredAll 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
The attribute name was retained as it was salient
The levels were reduced to three packages namely comprehensive, enhanced and basic. The comprehensive package had all services including complex diagnostic services, optical, and dental services
Services coveredComprehensive (All services including complex diagnostics e.g. imaging, optical and dental services)
Enhanced (consultation + laboratory services + drugs)
Basic (Consultation + drugs)
4. Autonomy to use capitation funds.Flexible
Rigid
The attribute was viewed as salient to public health care providers.
The panel decided that the terms “flexible” and “rigid” needed to be simplified to be understandable to health care providers. From the qualitative study, this attribute was specific to public providers as they had to first deposit the PPM funds into a pooled account run by the county governments. Then, they would wait for the county governments to reimburse the funds back to them after some time. This was a legal requirement in some counties. Therefore, levels were simplified from “flexible” to “do not have to pay the county first” and “rigid” to “pay the county first as usual.”
Autonomy to use capitation funds.Do not have to pay the county first.
Pay the county first as usual.
5. Payment schedule2 weeks
4 Weeks (Monthly)
3 months (Quarterly)
6 months (Bi-annually)
12 months (Annually)
The attribute name was viewed as salient and self-explanatory. It was therefore maintained.
The level “annual payments (12 months)” was viewed as far apart. Therefore, the level was dropped.
Payment schedule2 weeks
4 Weeks (Monthly)
3 months (Quarterly)
6 months (Bi-annually)
6. Predictability of payments in terms of timingTimely (Providers know when they will be paid).
Delays (Providers don’t know when they will be paid).
Predictable was viewed as a complex word. Therefore, the attribute name was changed to “payment patterns”.
The levels were simplified to include the words “timely” and “delayed”
This attribute was viewed to be similar to “payment schedule”. However, it differed from the first one as payment schedule might be set, but not followed.
Payment patternsTimely
Delayed
7. List of clients registered to a health facilityList available
List not available
Health care providers in Kenya did not have access to the list of enrolees registered to their health facilities. This was viewed by the panel to be a transparency issue rather than a capitation attribute. Therefore, the attribute was dropped as it was not relevant to the decision contextAttribute dropped as it was not relevant to decision context.
8. Predictability of payments in terms of amountPredictable – (Providers know the amount to expect)
Unpredictable (Providers don’t know the amount to expect).
Health care providers could not predict the total capitation amount they expected to receive from the purchaser (NHIF) as they did not know the number of clients registered to their health facilities. Therefore, this attribute was deemed to be correlated to the “list of clients registered to a health facility” attribute. Furthermore, it was viewed as a transparency from the purchaser issue rather than a characteristic of capitation. Therefore, the attribute was dropped.Attribute dropped due to inter-attribute correlation and irrelevance to decision context.
9. Complexity of accountability mechanismsSimple accountability requirements
Complex/burdensome accountability requirements
The attribute name was maintained as it was salient.
Unlike, FFS payments, the main accountability issue with capitation was notifying the NHIF every time an enrolee sought care at a health facility.
The levels were simplified by removing the word accountability
Complexity of accountability mechanismsSimple requirements
Complex requirements
10. Performance requirementsPayments linked to performance
Payments not linked to performance
The attribute name was maintained as it was salient. It was decided that the attribute and levels should delink individual performance from health facility performance. Since the attribute focussed on health facility performance rather than individual performance, the word “facility” was added to the attribute-levelsPerformance requirementsPayments linked to facility performance
Payments not linked to facility performance
  1. 1 US$ = Kenya shillings (KES) 100