Effects of Out-Of-Pocket Payment, Money Value on Insurance Claims and Patient Case Mix Index on Revenue Generation among Not-For-Profit Hospitals in Kisumu County, Kenya
Keywords:
Out of pocket payments, Monetary value of insurance claims, Patient Case Mix Index, Not-for-Profit hospitalsAbstract
Purpose: Effective revenue cycle has become crucial in today's hospital business environment. Hospitals are confronted with stricter regulations and billing requirements, more thorough preauthorization, and precertification, underpayments and greater delays in payments. This study provided an analysis of the determinants of revenue generation with key focus on out-of-pocket spending, money value of insurance claims and patient case mix index among not-for-profit hospitals in Kisumu County.
Methods: The study utilized Baumol’s model of sales maximization. A correlational research design was employed and secondary panel data was used from revenue statements of 39 not-for-profit hospitals in Kisumu County for the period 2019-2023. Data was analyzed using descriptive statistics and regression analysis and presented in the form of tables.
Results: A positive and significant relationship was found between out-of-pocket payments (β=0.259, P =0.002), monetary value on insurance claims (β=0.169, p=0.031), outpatient revenue (β= 0.152. P=0.031), inpatient revenue (β=0.244, P=0.000) and revenue generation.
Conclusion: The study concluded that when patients pay more out-of-pocket, more revenue is realized by hospitals. More insurance claims by the hospitals resulted in more revenue and the patient case mix index has a positive and significant relationship with revenue generation among Not-For-Profit Hospitals in Kisumu County. The study recommended that not-for-profit hospitals should encourage more patients to subscribe for health insurance coverage; a mix of inpatient and outpatient index be allowed as they both contribute to increased revenue generation; and the government should formulate policies that will guide the not-for-profit hospitals to come up with standardized charges to ensure they remain financially sound while providing quality and affordable services.
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Copyright (c) 2025 Innocent Alvin Weisiko, Dr. Scholastica Odhiambo, Dr. Yasin Ghabon
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