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Examining Tertiary Healthcare Quality Under Asset Leasing, Performance-Based Financing, and Social Impact Bonds: The
Ezekiel Karino1, James Ndegwa2, Vincent Were1
1Strathmore Business School (SBS) Strathmore University Nairobi Kenya.
Background And Aims:
Tertiary healthcare systems in low- and middle-income countries persistently suffer quality gaps due to inefficient financing and governance. Innovative healthcare financing mechanisms are increasingly promoted to improve service delivery in resource-constrained settings. This study examined the effects of these mechanisms-asset leasing financing (ALF), performance-based financing (PBF), and social impact bonds (SIB)-on the quality of tertiary healthcare in Kenya and assessed the moderating role of government stewardship.
Methods:
A cross-sectional quantitative study was conducted in three national referral hospitals in Kenya. Data were collected from hospital managers, clinical staff, and patients using structured questionnaires. Descriptive statistics, factor analysis, correlation analysis, and hierarchical multiple regression were applied.
Results:
Perceptions of tertiary healthcare quality were generally neutral to slightly negative across groups. All three financing mechanisms positively influenced the quality of tertiary healthcare. ALF (β = 0.50, p < 0.01) and PBF (β = 0.46, p < 0.01) showed strong effects, while SIB had a moderate effect (β = 0.28, p < 0.05). Together with traditional funding, these mechanisms explained 35% of the variance in tertiary quality. Including government stewardship improved explanatory power (R² = 0.45) and significantly moderated the effects of all three mechanisms (interaction β range: 0.28-0.32, p < 0.05). Strong stewardship amplified the impact of innovative financing through enhanced oversight, policy implementation, and resource management.
Conclusion:
Innovative healthcare financing mechanisms-ALF, ALF, PBF, and SIBs-are positively associated with the quality of tertiary healthcare in Kenya, with stronger effects observed under effective government stewardship. Strengthening stewardship and accountability frameworks may enhance the impact of financing reforms, offering evidence to inform health policy and managerial decision-making.
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