The Effect of Capitation Payment on the National Health Insurance Scheme in Ashanti Region, Ghana

Opoku, Michael; Nsiah, Richard; Oppong, Paul Atta; Tetteh, Edmund

doi:10.2139/ssrn.2479305

Cited by 6 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hence, they did not see any improvement and effectiveness in healthcare delivery in the Ashanti region. This finding, however, is also different from the findings of Opoku, Nsiah, Oppong and Tetteh [ 17 ] who undertook a similar study within the same Ashanti region and observed that the capitation payment system has an efficient use of resource, creates competition among hospitals (quality service), and has turned hospitals to financial risk bearers.…”

Section: Introductioncontrasting

confidence: 89%

Willingness to accept capitation payment system under the Ghana National Health Insurance Policy: do income levels matter?

Sackey

Amponsah

2017

Health Econ Rev

View full text Add to dashboard Cite

This research was set to examine the factors influencing the willingness and the likelihood of Ghanaians to accept the capitation payment system under the National Health Insurance Scheme. Data was collected through the random sampling method in all the ten regions of Ghana. A probit estimation with marginal effects was adopted to examine the factors influencing the willingness and the likelihood while the generalized Blinder-Oaxaca decomposition was used to examine the extent to which individual characteristics influence the acceptance gap between high income and low-income earners. Our results indicated that, at the individual level, high income, being employed, awareness and smaller household size were the significant factors influencing the willingness and the likelihood to accept capitation. We also observed that the acceptance gap between high income and low-income earners was largely influenced by unexplained factors other than individual characteristics of high income earners. Since the willingness and the likelihood to accept capitation are mixed across regions and largely dependent on high incomes, the intention to roll out and implement the capitation system should be as a complementary payment system to the already existing one, being the diagnosis related grouping. We recommend that the current payment system, the diagnosis-related-grouping be maintained and complemented with capitation while measures to reduce, if not eliminate, the abuse associated with it be put in place.Electronic supplementary materialThe online version of this article (10.1186/s13561-017-0175-1) contains supplementary material, which is available to authorized users.

show abstract

Section: Introductioncontrasting

confidence: 89%

Willingness to accept capitation payment system under the Ghana National Health Insurance Policy: do income levels matter?

Sackey

Amponsah

2017

Health Econ Rev

View full text Add to dashboard Cite

show abstract

“…10 The success or otherwise of the programme and/or its effect on patients is not within the purview of the present study. [11][12][13][14] The basis for patient choice is rooted in Hirschman's 15 principle of 'voting your feet. ' The general idea is that consumers have the option to withdraw or complain when there is a decline in the quality of service and/or benefit.…”

mentioning

confidence: 99%

Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana

Boachie

2015

Int J Health Policy Manag

View full text Add to dashboard Cite

Background: In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP. Methods: Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome. Results: Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level. Conclusion: Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels by ensuring constant availability of essential drugs, doctors, and shorter waiting time. However, individual enrolees may value each criterion differently. Thus, not all enrolees may be motivated by same concerns. This requires providers to be circumspect regarding the factors that may attract enrolees. The National Health Insurance Authority (NHIA) should also ensure timely release of funds to help providers procure the necessary medical supplies to ensure quality service.

show abstract

“…For example, Andoh-Adjei, Boudewijns, Nsiah-Boatenget al [ 38 ] showed that both healthcare utilization and claims fell after the introduction of capitation in the Ashanti region. Opoku, Nsiah, Opponget al [ 39 ] also showed that capitation led to efficient use of resources. A synthesis of the evidence showed that capitation is efficient as it reduced cost and provided a stable stream of revenue to healthcare providers.…”

Section: Introductionmentioning

confidence: 99%

Effect of capitation payment method on health outcomes, healthcare utilization, and referrals in Ghana

Boachie,

Amporfu

2024

PLOS Glob Public Health

View full text Add to dashboard Cite

Different provider payment systems generate different incentives for patients, providers, and purchasers. Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 and has made reforms to its provider payment methods to create incentives in providers for cost containment. Starting with the fee for service method, it shifted to the Diagnostic Related Group (DRG) method in 2008 to improve cost containment. In 2012 the NHIS began piloting capitation method of payment which has been suspended since 2017 to allow for thorough review. This study uncovers the association between capitation payment system and patient health outcomes, utilization of healthcare services and referral patterns in Ghana based on data collected between November 2012 and January 2013. Using a cross-sectional data on 500 malaria patients who were enrollees of the NHIS from the two payment plans (i.e., capitation and DRG plan), ordered logit, negative binomial and logit regression results showed that patients under capitation were 11.9% less likely to report better health and had 1.583 fewer visits relative to patients under DRG. In relation to referrals, capitated providers were more likely to refer patients than under DRG plans. In the capitated region, better health outcomes were reported by patients of private health facilities. Capitation in Ghana was associated with under-provision of care, hence decreasing any efficiency gain from the reform. Implementors of capitation need to ensure a good monitoring and evaluation system for adequate provision of quantity and quality of care. Some limitations of this study include the use of cross sectional rather that panel data which follows individuals over time and therefore may be more able to provide definite information about cause-and-effect relationships. It also does not account for events before and after the introduction of any payment method. Overall, this study provides valuable information on the implementation policy for reintroducing capitation.

show abstract

The Effect of Capitation Payment on the National Health Insurance Scheme in Ashanti Region, Ghana

Cited by 6 publications

References 18 publications

Willingness to accept capitation payment system under the Ghana National Health Insurance Policy: do income levels matter?

Willingness to accept capitation payment system under the Ghana National Health Insurance Policy: do income levels matter?

Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana

Effect of capitation payment method on health outcomes, healthcare utilization, and referrals in Ghana

Contact Info

Product

Resources

About