Browsing by Author "Ndede, Fredrick"

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    Factors Influencing Reimbursement of Hospital Financial Claims by Private Health Insurance Companies in Kenya
    (Health Systems Management Journal, 2019-07-20) Magondu, Richard Wachira; Tenambergen, Mwaura Wanja; Ndede, Fredrick
    Introduction: Despite the positive aspect of private health insurances, a number of challenges related to claims reimbursement for services offered to the insured have been raised. According to lean Six Sigma Improvement Project conducted in 2014 in a private hospital in Nairobi, Kenya, the top seven medical insurance companies that contributed to 40% of the corporate insurance business rejected over 4% of their total claims amounting to Kenya Shillings 214million over three years between 2011 and 2013. Even when claims are not disputed, the hospital usually experience delays in reimbursement sometimes up to 45 debtor days which is above the 30 days period stated on the contractual agreement. The broad objective of this study was to find out factors influencing payment of hospital claims by private insurance companies at a tertiary private hospital in Nairobi, Kenya. Specifically, this study sort to determine how hospital related factors, private health insurance related factors and insured related factors influence reimbursement of hospital claims by the private insurance firms. Methods: This was a cross-sectional research design using a semi-structured questionnaire to collect data. Data was collected from 94 staff members who were initially stratified by job category and thereafter randomly selected within each strata. Results: Hospital related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.548, P < .001); (β1 = .269, P < .001). Insurance related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.385, P < .001); (β2 = .226, P < .001). Insured related factors positively and significantly influences the reimbursement of hospital claims by private insurance firms (r =.273, P = .008); (β3 = .245, P < .001). The value β0 was also significant meaning that even without the three variables of interest in this study a certain minimum reimbursement will always exist. Conclusion: A continuous feedback to the employees on factors that hinder timely and full reimbursement and regular training of the employees on adherence to insurance protocol and guidelines will improve reimbursement rates. This will be further enhanced by Tailor-making the billing system to meet end users’ needs and having strategies on effective dissemination of information to the health providers and the insured clients, automation of claim processes, Continuous policy education to the insured and Stakeholders relationship to be enhanced.
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    Influence of Expanded Free Maternal Care Programme on Delivery of Quality Health Care i n Maternity Units in Kajiado County
    (Health Systems Management Journal, 2019-07-20) Magondu, Richard Wachira; Tenambergen, Mwaura Wanja; Ndede, Fredrick
    Introduction: A well-functioning health system works in harmony among the building blocks: trained and motivated health workers, functional infrastructure, consistent supply of essential medicines and technologies, health information management, and sufficient funding. Africa is uniquely affected by maternal health challenges with a maternal mortality estimated at 686/100,000 live births. Kenya has high maternal mortality estimated at 360/100,000 live births. These deaths are avoidable with proper medical intervention. This study sought to assess quality of service delivery in maternity units of health facilities currently implementing expanded free maternal care programme in Kajiado County. It was guided by one general and four specific objectives: To establish how essential drugs, medical equipment, health workers and basic amenities influence quality of service delivery in maternity units of health facilities currently implementing expanded free maternal care programme in Kajiado County. Methods:The study adopted descriptive cross sectional design of survey, with midwives, clinical officers and medical officers being the target population. Since the target population was small a census was carried out. 44 self-administered questionnaires were used; the questionnaires were pre-tested for reliability using Cronbach’s-Alpha. Descriptive and inferential statistics were used to provide population details and make inferences based on data collected. Results:68% of the health facilities surveyed were dispensaries (Level 2), 23% were Health centres (Level 3), 7% were Sub County referral hospitals (Level 4) while 2% were County referral hospital (level 5). Oxytocin injectable was partly out of stock in 64% of health facilities while Magnesium sulphate was always available in only 5% 58% of assessed health facilities had a sterile delivery set. Only 18% of respondents agreed that their facilities had adequate skill mix of health workers. None of the independent variable had coefficient > 0.05 hence no problem of multi-collinearity, the probability value, p was <0.05 indicating the model used was entirely significant. Conclusion:Results show independent variables individually and combined significantly influenced provision of quality of health care in maternity units in Kajiado County Kenya