Causes and effects of delayed reimbursement to accredited health facilities by national health Insurance fund in delivery of health services: A case of regency medical hospital and NHIF head office
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Mzumbe University
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A Research Report Submitted to School of Public Administration and Management
(SOPAM) in Partial Fulfillment for the Requirement of Degree of Master of Public
Administration in Health Systems Management (MHSM)
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.
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.
Keywords
National Health Insurance Fund, Insurance-health services