Table 8 Researchers’ comments and decisions on capitation attributes and levels
| Initial attribute name | Initial levels | Comments by researchers | New attribute name | New levels |
|---|---|---|---|---|
| 1. Capitation amount | 1200 per individual per year 2400 per individual per year 3600 per individual per year 4800 per individual per year | The attribute was renamed ‘capitation rate per individual per year’ to emphasise the fact that the rate stated was for an individual enrolee per year. The levels were simplified by rewording and adding the local currency (shillings). | Capitation rate per individual per year. | 1200 shillings 2400 shillings 3600 shillings 4800 shillings |
| 2. Services covered | Comprehensive (All services including complex diagnostics e.g. imaging, optical and dental services) Enhanced (consultation + laboratory services + drugs) Basic (Consultation + drugs) | The attribute was reworded to ‘services to be paid by the capitation rate’ to emphasise the range of services the capitation rate was paying for. The levels expounded to emphasise the fact that providers would not turn away enrolees seeking care if the services were not being paid by the capitation rate. They could claim separately for services not included if they provided them to patients. For example, the insurer might pay for consultation, drugs, and lab tests by capitation, OR pay for consultation and drugs only by capitation, and pay for lab tests separately using another method such as FFS. | Services to be paid by the capitation rate | Capitation rate pays for consultation only. (Hospital claims and is paid for lab tests and drugs separately by the insurer/NHIF). Capitation rate pays for consultation and drugs only (Hospital claims and is paid for lab tests separately by the insurer/NHIF). Capitation rate pays for consultation and lab tests only. (Hospital claims and is paid for drugs separately by the insurer/NHIF). Capitation rate pays for consultation, lab tests, and drugs |
| 3. Autonomy to use capitation funds. | Do not have to pay the county first. Pay the county first as usual. | The attribute was dropped as the issue was not viewed as a PPM characteristic, rather a systemic problem which differed by counties (sub-national regions). | Attribute dropped as it was irrelevant to the decision context | |
| 4. Payment schedule | 2 weeks 4 Weeks (Monthly) 3 months (Quarterly) 6 months (Bi-annually) | The attribute name was maintained. As for the levels, two weeks was viewed as short and not plausible for capitation payments. Therefore, it was dropped. Annual payments “12 months” even though had initially been viewed by panel of experts as far apart, was reinstated by the researchers as it thought to be plausible. | Payment schedule | 1 month 3 months 6 months 12 months |
| 5. Payment patterns | Delayed Timely | The attribute name was changed to timeliness of payments as it would be easily understandable to the respondents. The levels were maintained | Timeliness of payments | Delayed Timely |
| 6. Complexity of accountability mechanisms | Simple requirements Complex requirements | The attribute name was simplified by deleting the word ‘complexity’. Furthermore, the researchers felt that ‘complexity’ framed the attribute negatively. A note was added to expound on what the levels meant. The attribute was dropped as capitation did not have a reporting mechanism | Attribute dropped as it was irrelevant to the decision context | |
| 7. Performance requirements | Payments not linked to facility performance Payments linked to facility performance | The attribute name was maintained as it was salient The levels were reworded to expound on what performance entailed. | Performance requirements | Hospital receives base/fixed capitation rate Hospital receives base/fixed capitation rate + bonus for improved performance (e.g. improved quality) |