Does a provider payment method affect membership retention in a health insurance scheme? a mixed method study of Ghana's capitation payment for primary care

Autor: Koos van der Velden, Francis-Xavier Andoh-Adjei, Ernst Spaan, Renske van der Wal, Eric Nsiah-Boateng, Felix Ankomah Asante
Rok vydání: 2018
Předmět:
medicine.medical_specialty
National Health Programs
media_common.quotation_subject
Health Personnel
Sample (statistics)
Affect (psychology)
Ghana
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Health administration
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
0302 clinical medicine
Health insurance
Health care
Medicine
Humans
030212 general & internal medicine
Socioeconomics
GeneralLiterature_REFERENCE(e.g.
dictionaries
encyclopedias
glossaries)
Diagnosis-Related Groups
media_common
Insurance
Health
Primary Health Care
Membership retention
business.industry
030503 health policy & services
Health Policy
Public health
Nursing research
lcsh:Public aspects of medicine
Fee-for-Service Plans
lcsh:RA1-1270
Payment
Capitation payment
Trend analysis
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Health Expenditures
0305 other medical science
business
Research Article
Zdroj: BMC Health Services Research, Vol 18, Iss 1, Pp 1-11 (2018)
BMC Health Services Research
BMC Health Services Research, 18, pp.
BMC Health Services Research, 18,
ISSN: 1472-6963
Popis: Background Ghana 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. Methods We 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. Results Results 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. Conclusion Capitation 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. Electronic supplementary material The online version of this article (10.1186/s12913-018-2859-6) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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