Rolling Out the Capitation Payment System in Ghana: Lessons from the Pilot Implementation in Ashanti Region

Abstract

This paper discusses the introduction of Capitation as a method of paying health care providers under Ghana's National Health Insurance Scheme. Currently, care providers under the scheme are reimbursed with fee-for-service payment system and Diagnosis Related Group system. In 2012, capitation was introduced on pilot basis in the Ashanti Region to help the scheme control cost and ensure financial sustainability of the scheme. The scheme is looking forward to nationwide rollout of the capitation system after a successful pilot implementation. The pilot program has, however, been bedeviled with some challenges that need to be resolved before the nationwide implementation. One major challenge is insufficiency of funds for health care providers who are paid under the capitation. There is therefore a high probability that health care providers would provide low quality services in order to cut down cost. We argue that the cost burden on health care providers can be attributed to two main factors. First, the capitation rate per person under the scheme is not risk-adjusted. Secondly, moral hazard behaviours on the part of clients have not been adequately dealt with. We recommend that these factors be adequately dealt with before the nationwide implementation.