Role of third party administrators in setting up managed health care systems: a case of Henner Groupe Kenya

Abstract

This study attempted to establish the role of TP A in setting up managed health care systems with special reference to Henner Groupe Kenya. The study adopted a descriptive research design targeting the member organization/clientele at United Nations environmental programme (UNEP) United nations development Programme (UNDP); World Food Programme (WFP) covered by Henner Group Kenya. Using stratified sampling technique, a sample size of 480 respondents was selected, proportionately, from the target population. Questionnaires were used as the main instrument of data collection. Descriptive statistics was adopted to analyze the data (means, standard deviation, frequency and percentages).

Multiple regression analysis was used determine the significance of the relationship. The study's findings shows that GMC/Henner Groupe have adopted a healthcare financing system whereby it covers part of the medical cost for both inpatient and outpatient medical expenses. The TP A reimburses the policyholders' claims whenever they pay for their medical cost. GMC/Henner Group monitors and collects necessary information, documents and bills pertaining to the policyholders' treatment, thus, eases health care insurance workload both administrative and money costs. GMC/Henner Group are efficient in policy-related enquiries and makes arrangements for ambulance, helicopter evacuation, medicines supplies, information on health facilities available among others.

The study, therefore, recommends that TP As have enhanced healthcare systems through its reimbursement, medical cost containment and call centre support. The study recommends that policymakers create environment both legislatively and monetarily favourable for TP As so as to improve the healthcare management system in Kenya.