Reimbursement Practices And Budgetary Implications In The Implementation Of Waivers And Maternity Care Exemption Policy In A Sub-County Referral Hospital

ABSTRACT

The waiver and free maternity policies play a major role in enhancing equity and access to health care services among the poor and the pregnant mothers respectively. However, for the policies to be successful, there is need for regular and sustainable reimbursement practices to cater for the loss of the user fees exempted or waived. Lack of reliable reimbursement practices have huge budgetary implications on hospital management and results to hospitals adopting to coping mechanisms that are dysfunctional to the public health system. A mixed methodology was carried out qualitatively amongst five key respondents directly involved in the implementation process of both waiver and free maternity policy and quantitatively to obtain data on reimbursement practices of both waivers (23) and maternity services exemptions (1,151) within the study period. The data was analyzed through content analysis for qualitative data and descriptive analysis for quantitative data. The study revealed that the implementation status of waivers and exemptions faces financial challenges at the hospital studied. The waiver policy was neither funded nor budgeted for resulting to the facility issuing waivers to approximately 10% of eligible patients. The exemption policy for maternal care received irregular reimbursements which caused inefficiencies in the facility including shortage of drugs and consumables, late payments of utility bills, huge debts with suppliers, budgetary deficits, and decreased available revenue for hiring more staff to cater for increased service utilization. The employees cited demotivation and dissatisfaction due to the increased workload and lack of a compensation mechanism. The annual costs of waivers and exemptions relative to the reimbursement rate was very high and if this is not reevaluated, it would cripple the financial status of the hospital. The hospital had no sustainable coping mechanism besides operating on huge debts and cutting costs while allocating resources. In conclusion, irregular reimbursement of exemptions or lack of them in waivers have huge budgetary implications that have contributed to a dysfunctional public health care facility.