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This study investigated the causes and effects of reimbursement delays of the National
Health Insurance Fund (NHIF) to health facility, the specific objectives were to determine
the causes of delays of reimbursement to accredited health facilities by NHIF in delivery of health service and to find out the effects of delay of reimbursement to health facilities in provision of health service.
The study adopted a qualitative case study design, the sample size comprised of 100
respondents from NHIF beneficiaries, NHIF staff and Regency Medical Hospital staff.
Data were collected using questionnaires, interviews and documentary review. The
collected data were analyzed quantitatively and qualitatively.
The study found that the causes of delays in reimbursement are fraud, bureaucracy from
both NHIF and HF, inaccuracy information filled by health provider to the NHIF patient
forms and shortage of staff at NHIF. Delay has negative impact on stock of medicines and medical consumables in HF, motive of health providers to serve NHIF members and timely provision of salary and incentives to health facility staffs.
The study recommended that, Anti-fraud Association should be established to detect,
investigate, prosecute and ultimately prevent fraud against health insurance system. To
improve data quality and make sure that patient information recorded by health providers
for claiming payments are accurate, reduce number of steps for payments process. NHIF should also consider hiring more people especially at the claim department. |
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