‘New Wine in Old Wine Skin’: Public Perceptions of NHIS Per-Capita Payment System and Implications for Health-Seeking Behavior in Ghana

Abstract

The article examines public perceptions of capitation payment system and the implications for health-seeking behavior in rural and urban Ghana. Drawing on qualitative approach, the study employed focus groups (n = 20), in-depth (n = 20), and key informant (n = 14) interviews with community-based adult men and women, aged 18–65 years in Ashanti Region. Tape recorded interviews were transcribed and analyzed thematically. Results indicated that majority of respondents have heard about the capitation but only a small proportion of them understood what the whole policy entails and the rationale for its introduction. While general dissatisfaction with and negative perceptions of the capitation still persisted among majority of the study population, this did not translate into nonuse of health services. For subscribers to derive optimal benefits from the capitation, political commitment in continuing public education using the most accessible media modulation is key. More importantly, public and private healthcare providers should increase investments in improving healthcare delivery system. Future studies should employ quantitative approaches with region-wide sample in order to confirm the relationships between capitation enrollment and health-seeking behavior.