Fraud Management Strategies and Performance of Medical Insurance Providers in Nairobi City County, Kenya
| dc.contributor.author | Maina, Antony Kinyuru | |
| dc.date.accessioned | 2024-08-09T12:23:46Z | |
| dc.date.available | 2024-08-09T12:23:46Z | |
| dc.date.issued | 2024-05 | |
| dc.description | A Research Project Submitted to the School of Business Economics and Tourism in Partial Fulfilment of the Requirements for the Award of the Degree of Master of Business Administration (Strategic Management Option), of Kenyatta University. May, 2024 supervisor Njeri Njuguna | |
| dc.description.abstract | Globally, medical insurance is pivotal in financing healthcare, significantly impacting performance of healthcare systems. However, the effectiveness of this contribution is hindered by the pervasive issue of medical insurance fraud, which poses a serious challenge to cost-effective healthcare systems worldwide. Over recent years, medical insurance providers operating in Kenya have consistently reported dismal performance, as evidenced in their financial statements. Between 2016 and 2018, the average annual underwriting loss amounted to KSh. 792 million, with 2018 alone recording an underwriting loss of KShs. 1.1 billion. An alarming 70 percent of medical insurance providers have sustained underwriting losses for a continuous period of more than five years. This chronic underperformance is primarily attributed to the persistent fraudulent activities plaguing these companies. The primary objective of this research was to assess effects of implementing fraud management strategies on the organizational performance of medical insurance providers in Nairobi City County, Kenya. To achieve this, the study's specific objectives delved into investigating the influence of fraud prevention, fraud detection, and fraud response strategies on the performance of medical insurance providers in Nairobi City County, Kenya. The theoretical literature review is draws upon the Fraud Triangle Theory, Resource-Based View, and the Balanced Scorecard model. The study employed a descriptive and explanatory research design, which is cross-sectional in nature. The target population consisted of 2891 employees from the 27 medical insurance providers licensed by the Insurance Regulatory Authority in Kenya and operating across Nairobi City County. The study utilized a convenience sampling approach and collected primary data through self-administered semi-structured questionnaires. The questionnaire underwent a pilot test to ensure content and criteria-related validity. The research instrument’s reliability was assessed using the Cronbach alpha coefficient, with a minimum threshold of 0.7. The study's data was analyzed using both descriptive and inferential statistics, and the results are presented in the form of tables, figures, charts, frequencies, and percentages. The research ensured the confidentiality of the gathered information and secured voluntary participation by obtaining informed consent before questionnaire administration. The study's findings revealed a positive and significant influence of fraud prevention, detection, and response strategies on the performance of medical insurance providers. The study underscores the importance for medical insurance providers to follow regulatory guidelines and compliance standards in their fraud prevention strategies, emphasizing a holistic approach integrating prevention, detection, and response strategies, while also highlighting the significance of upholding ethical standards, conducting thorough background checks, and implementing agile fraud response protocols to safeguard against financial losses and preserve organizational reputation. The study emphasizes the need for medical insurance providers to adhere to regulatory guidelines and ethical standards, integrate a holistic approach encompassing prevention, detection, and response strategies, and establish adaptive fraud response strategies, including specialized teams, to effectively combat fraud while safeguarding customer privacy and organizational integrity. The study suggests a follow-up research to verify its findings on fraud management strategies' impact on MIPs' performance in Nairobi City County, urging a broader study across various sectors due to its limited sample size of 71 respondents; as only 60.6 percent of performance influence was explained by three variables, further investigation into unaccounted factors is essential, highlighting the need for future research with wider geographical coverage and diverse research designs for generalizability. | |
| dc.description.sponsorship | Kenyatta University | |
| dc.identifier.uri | https://ir-library.ku.ac.ke/handle/123456789/28637 | |
| dc.language.iso | en | |
| dc.publisher | Kenyatta University | |
| dc.title | Fraud Management Strategies and Performance of Medical Insurance Providers in Nairobi City County, Kenya | |
| dc.type | Thesis |