Abstract
BackgroundGhana introduced a National Health Insurance Scheme (NHIS) in 2003 applying fee-for-service method for paying NHIS-credentialed health care providers. The National Health Insurance Authority (NHIA) later introduced diagnosis-related-grouping (DRG) payment to contain cost without much success. The NHIA then introduced capitation payment, a decision that attracted complaints of falling enrolment and renewal rates from stakeholders. This study was done to provide evidence on this trend to guide policy debate on the issue.MethodsWe applied mixed method design to the study. We did a trend analysis of NHIS membership data in Ashanti, Volta and Central regions to assess growth rate; performed independent-sample t-test to compare sample means of the three regions and analysed data from individual in-depth interviews to determine any relationship between capitation payment and subscribers’ renewal decision.ResultsResults of new enrolment data analysis showed differences in mean growth rates between Ashanti (M = 30.15, SE 3.03) and Volta (M = 40.72, SE 3.10), p = 0.041; r = 0. 15; and between Ashanti and Central (M = 47.38, SE6.49) p = 0.043; r = 0. 42. Analysis of membership renewal data, however, showed no significant differences in mean growth rates between Ashanti (M = 65.47, SE 6.67) and Volta (M = 69.29, SE 5.04), p = 0.660; r = 0.03; and between Ashanti and Central (M = 50.51, SE 9.49), p = 0.233. Analysis of both new enrolment and renewal data also showed no significant differences in mean growth rates between Ashanti (M = − 13.76, SE 17.68) and Volta (M = 5.48, SE 5.50), p = 0.329; and between Ashanti and Central (M = − 6.47, SE 12.68), p = 0.746. However, capitation payment had some effect in Ashanti compared with Volta (r = 0. 12) and Central (r = 0. 14); but could not be sustained beyond 2012. Responses from the in-depth interviews did not also show that capitation payment is a key factor in subscribers’ renewal decision.ConclusionCapitation payment had a small but unsustainable effect on membership growth rate in the Ashanti region. Factors other than capitation payment may have played a more significant role in subscribers’ enrolment and renewal decisions in the Ashanti region of Ghana.
Highlights
Ghana introduced a National Health Insurance Scheme (NHIS) in 2003 applying fee-for-service method for paying NHIS-credentialed health care providers
In 2012, the year of capitation implementation in the Ashanti, the Ashanti region recorded a negative growth of − 37.3% while Volta and Central regions recorded positive growth rates of 8.9% and 1.5%, respectively
This argument is supported by an earlier study that found that notwithstanding people’s negative attitude towards the capitation payment, a majority of survey respondents expressed their willingness to renew their membership card when it expires [33] and by our individual in-depth interviews which indicate that apart from the discomfort that respondents expressed with the capitation and its preferred primary care provider (PPP) arrangement, which is consistent with findings by Pereira et at [34], capitation per se was not an important factor in their decision to enrol or renew their membership with the NHIS
Summary
Ghana introduced a National Health Insurance Scheme (NHIS) in 2003 applying fee-for-service method for paying NHIS-credentialed health care providers. Since no country in the world has unlimited funds for their health sector, policy-makers complement the income-side interventions with expenditure side interventions while being conscious of quality care delivery [3] One such expenditure-side intervention is reform of the provider payment systems [4] which is intended to influence efficient application of resources in health care delivery [5]. The objectives for the capitation payment were to contain cost by sharing financial risk among schemes, providers and subscribers; introduce managed competition among providers provide patients with the opportunity to choose their preferred primary care provider (PPP), improve efficiency and effectiveness of health service delivery through more rational resource use, correct the adverse effects of the G-DRG and to address difficulties in forecasting and budgeting
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