Knowledge, perceptions and expectations of capitation payment system in a health insurance setting: a repeated survey of clients and health providers in Kumasi, Ghana.

Peter Agyei-Baffour,Regina Oppong,Daniel Boateng

doi:10.1186/1471-2458-13-1220

Peter Agyei-Baffour, Regina Oppong + Show 1 more

Open Access

https://doi.org/10.1186/1471-2458-13-1220

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Abstract

BackgroundHealth insurance is improving access to quality health care in Ghana. However, there are implementation challenges which call for reform of the current health insurance system. There is no doubt that reforming the current health insurance in Ghana is besieged with a myriad of problems due to misconceptions and misinformation. This study explored the perceptions and understanding of clients and health providers on the capitation payment system in the Kumasi metropolis.MethodsThe study employed a cross - sectional design and repeated surveys were conducted with a cohort of 422 NHIS policy holders aged 18–69 years in each survey. The surveys were conducted in every three months. Health service providers and clients from thirteen (13) Hospitals, seven (7) Maternity homes and twenty (20) Clinics were also interviewed. Data was collected with interviewer–administered questionnaires. STATA software (version 11) was used for cleaning, standardizing and analysing data.ResultsA majority, 97.9% of the clients interviewed had heard of capitation payment although this did not translate into their level of understanding. About two-thirds, 61.2% disclosed that capitation was not important to them as clients are restricted to one Preferred Primary Provider (PPP) for a long period of time. About 94% of health providers also believed that people did not like the capitation payment system due to their misconception that it has been politicized (34%); does not give clients free choice of providers (26%) and capitation not covering most drugs (17%).ConclusionAlthough awareness of the capitation was high among clients, attitudes towards the capitation payment system were somewhat poor. A good understanding of the capitation payment system is key to ensuring client and provider acceptance and smooth implementation of the system.

Highlights

Health insurance is improving access to quality health care in Ghana
Ghana has experimented many health care financing mechanisms spanning from Free Health Care System (FHCS) through ‘meager’ fee for service to fee for service called the “cash and carry” system where cost of health care was borne by patients and quite recently, health insurance
The ceaselessness of implementation obstacles to health care financing mechanisms in Ghana necessitated the introduction of the National Health Insurance Scheme (NHIS) in 2004

Summary

Introduction

Health insurance is improving access to quality health care in Ghana. there are implementation challenges which call for reform of the current health insurance system. Ghana has experimented many health care financing mechanisms spanning from Free Health Care System (FHCS) through ‘meager’ fee for service to fee for service called the “cash and carry” system where cost of health care was borne by patients and quite recently, health insurance. These previous systems did not survive due to many implementation challenges. The FFS used the Ghana Diagnostic Relation Groupings (G-DRG) where providers billed the scheme based on diagnosis with reference to a new medicines list for treatment that was introduced Alternative payment mechanism, capitation one of the proposed payment mechanisms in the NHI programme, became the obvious choice for experiment

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