Abstract:
Provider payment mechanisms (PPMs) are important to the universal health coverage
(UHC) agenda as they can influence healthcare provider behaviour and create incentives
for health service delivery, quality and efficiency. Therefore, when designing PPMs, it is
important to consider providers' preferences for PPM characteristics. We set out to
uncover senior health facility managers' preferences for the attributes of a capitation
payment mechanism in Kenya. We use a discrete choice experiment and focus on four
capitation attributes, namely, payment schedule, timeliness of payments, capitation rate
per individual per year and services to be paid by the capitation rate. Using a Bayesian
efficient experimental design, choice data were collected from 233 senior health facility
managers across 98 health facilities in seven Kenyan counties. Panel mixed multinomial
logit and latent class models were used in the analysis. We found that capitation
arrangements with frequent payment schedules, timelier disbursements, higher payment
rates per individual per year and those that paid for a limited set of health services were
preferred. The capitation rate per individual per year was the most important attribute.
Respondents were willing to accept an increase in the capitation rate to compensate for
bundling a broader set of health services under the capitation payment. In addition, we
found preference heterogeneity across respondents and latent classes. In conclusion, these
attributes can be used as potential targets for interventions aimed at configuring capitation
to achieve UHC.