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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

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

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2018
Autoren:
Francis-Xavier Andoh-Adjei, Renske van der Wal, Eric Nsiah-Boateng, Felix Ankomah Asante, Koos van der Velden, Ernst Spaan
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-018-2859-6) contains supplementary material, which is available to authorized users.

Abstract

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.
Zusatzmaterial
Additional file 1: NHIS membership dataset - new enrollment, renewal and total active membership data on NHIS subscribers in the Ashanti, Volta and Central regions of Ghana from 2009 to 2014. (XML 129 kb)
12913_2018_2859_MOESM1_ESM.xml
Additional file 2: Interview guide – interview questions posed to respondents during the individual in-depth interviews in the Ejuiso district and Subin sub-metro of the Ashanti region. (DOCX 18 kb)
12913_2018_2859_MOESM2_ESM.docx
Additional file 3: Ejuiso interview results – responses/statements from respondents in Ejuiso district of the Ashanti region. (DOCX 36 kb)
12913_2018_2859_MOESM3_ESM.docx
Additional file 4: Subin sub-metro interview results – responses/statements from respondents in Subin sub-metro of the Ashanti region. (DOCX 29 kb)
12913_2018_2859_MOESM4_ESM.docx
Literatur
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