Digital transformation strategy and performance of e-claims systems at National Health Insurance Fund, Kenya

Abstract

The automation of health claims and the implementation of an advanced claims management system plays a crucial role in ensuring high-quality healthcare for patients. Claims processing is a vital function for insurance companies, as the speed and convenience with which claims are handled directly impact the overall reputation of the insurer. In Kenya alone, approximately 30 million medical claims are processed annually. However, an inefficient claims management system presents significant challenges, including high costs, time consumption, and increased instances of medical fraud. This research examined the effect of digital transformation strategy on the performance of e-claims systems at the National Health Insurance Fund in Kenya. The study objectives included assessing the impact of integrating digital technologies, evaluating the effect of data security compliance, examining the role of user experience, and determining the effect of interoperability with external systems on the performance of e-claims systems. The study was grounded in the Innovation Diffusion Theory, Resource-Based Theory, and Digital Business Transformation Framework. A case study research design was employed, targeting 166 employees at the National Health Insurance Fund headquarters. The sample size was determined using Yamane’s formula, resulting in 95 respondents. Stratified random sampling was utilized as the sampling procedure. Data analysis was conducted using SPSS version 27.0, encompassing preliminary analysis, and descriptive and inferential analysis. Measures of central tendency (mean, median, and mode) were employed to describe the data set, while measures of variability (range, standard deviation) will assess data dispersion. Pearson Correlation Analysis and multiple regression models were employed. The results were presented using tables and figures. The study results found that integration of digital technologies significantly affects the performance of E-Claims Systems (B = .646, p < .001); data security compliance has a significant and positive effect on the performance of E-Claims Systems (B = .528, p < .001); user-experience has a significant and positive effect on the performance of E-Claims Systems (B = .618, p < .001) and that compatibility with external systems has a significant and positive effect on the performance of E-Claims Systems (B = .703, p < .001). The study concludes that the integration of digital technologies, data security compliance, user experience, and interoperability with external systems is integral to enhancing E-Claims Systems performance at NHIF. The general recommendation for the study is to prioritize the integration of digital technologies, ensure data security compliance, optimize user experience, and foster interoperability with external systems within E-Claims Systems at NHIF.