Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana

Abstract

IntroductionGhana introduced capitation payment under National Health Insurance Scheme (NHIS), beginning with pilot in the Ashanti region, in 2012 with a key objective of controlling utilization and related cost. This study sought to analyse utilization and claims expenditure data before and after introduction of capitation payment policy to understand whether the intended objective was achieved.MethodsThe study was cross-sectional, using a non-equivalent pre-test and post-test control group design. We did trend analysis, comparing utilization and claims expenditure data from three administrative regions of Ghana, one being an intervention region and two being control regions, over a 5-year period, 2010–2014. We performed multivariate analysis to determine differences in utilization and claims expenditure between the intervention and control regions, and a difference-in-differences analysis to determine the effect of capitation payment on utilization and claims expenditure in the intervention region.ResultsFindings indicate that growth in outpatient utilization and claims expenditure increased in the pre capitation period in all three regions but slowed in post capitation period in the intervention region. The linear regression analysis showed that there were significant differences in outpatient utilization (p = 0.0029) and claims expenditure (p = 0.0003) between the intervention and the control regions before implementation of the capitation payment. However, only claims expenditure showed significant difference (p = 0.0361) between the intervention and control regions after the introduction of capitation payment. A difference-in-differences analysis, however, showed that capitation payment had a significant negative effect on utilization only, in the Ashanti region (p < 0.007). Factors including availability of district hospitals and clinics were significant predictors of outpatient health care utilization.ConclusionWe conclude that outpatient utilization and related claims expenditure increased in both pre and post capitation periods, but the increase in post capitation period was at slower rate, suggesting that implementation of capitation payment yielded some positive results. Health policy makers in Ghana may, therefore, want to consider capitation a key provider payment method for primary outpatient care in order to control cost in health care delivery.Electronic supplementary materialThe online version of this article (10.1186/s13561-018-0203-9) contains supplementary material, which is available to authorized users.

Access to Maternal Healthcare Services under the National Health Insurance Policy in the Upper West Region, Ghana

“…In 2003, Ghana introduced a NHIS as a measure to safeguard its population against out-pocket-payment at the point of accessing healthcare services [21] particularly maternal healthcare services. It is, however, important to note that the NHIS policy recognises that some sections of the society may not be able to make the minimum contribution to the scheme [22]. As a result, children under 18 years old, elderly above 70 years old, Social Security and National Insurance Trust (SSNIT) pensioners, pregnant women, and extreme poor do not pay the premium [22].…”

“…It is, however, important to note that the NHIS policy recognises that some sections of the society may not be able to make the minimum contribution to the scheme [22]. As a result, children under 18 years old, elderly above 70 years old, Social Security and National Insurance Trust (SSNIT) pensioners, pregnant women, and extreme poor do not pay the premium [22]. This signals that exemption of pregnant women from paying the premium seeks to do away with financial barriers to maternal healthcare services and thus, to reduce or eradicate pregnancy-related deaths.…”

Preferences of healthcare providers for capitation payment in Kenya: a discrete choice experiment

“…While several studies in low- and middle-income (LMIC) settings have explored healthcare providers’ views of—and experiences with—capitation payment schemes ( Agyei-Baffour et al , 2013 ; Andoh-Adjei et al , 2018 ; Sieverding et al , 2018 ; Suchman, 2018 ; Wangai et al , 2019 ), very few have sought to quantify provider preferences for the payment mechanism. A notable exception is Robyn et al (2012) who conducted a DCE among health workers in Burkina Faso to elicit their preferences for the attributes of capitation used in a community-based health insurance (CBHI) scheme.…”

Effect of a prospective payment method for health facilities on direct medical expenditures in a low-resource setting: a paired pre-post study

“…The payment methods used by states (purchasers) vary across countries ( Witter et al , 2010 , 2016 ; Richard et al , 2013 ; Wang et al , 2017 ; Andoh-Adjei et al , 2018 ). Table 1 summarizes the payment methods used in some African countries with cost-reduction policies.…”

“…The effects of these various payment methods on direct medical expenses (the portion of health expenditures usually covered by these policies), and therefore on the sustainability of these policies, have been minimally explored. A before-after controlled study conducted in three regions in Ghana showed that the shift from diagnosis-related groupings to a capitation payment method did not significantly reduce the expenditures for services provided ( Andoh-Adjei et al , 2018 ). In Burkina Faso, a pre-post study comparing the direct medical expenditures associated with deliveries during a case-based reimbursement period to those during a fee-for-service (FFS) reimbursement period in two health districts found that the direct expenditures significantly increased in some health facilities, decreased in others or remained unchanged in a third group.…”