Association between Healthcare Provider Payment Systems and Health Outcomes in Ghana

Boachie, Micheal Kofi and Amporfu, Eugenia (2021): Association between Healthcare Provider Payment Systems and Health Outcomes in Ghana.

Abstract

Different payment systems generate different incentives for patients, providers, and purchasers. This study uncovers the effect of provider-payment methods on patient health outcomes, utilization of healthcare services and referral patterns in Ghana. Using data on 250 enrollees of the National Health Insurance Scheme (NHIS) from each payment plan (i.e., capitation and Diagnosis Related Groupings/fee-for-service plans), ordered logit, negative binomial and logit regression results showed that patients under capitation were 4.6% less likely to report better health and had 29% fewer visits relative to patients under DRG/FFS. In relation to referrals, capitated providers were more likely to refer patients than under DRG/FFS plans. Better health outcomes were reported by patients of private health facilities. Capitation in Ghana led to under-provision of care and cost-shifting, hence decreasing any efficiency gain from the reform. Purchasing of healthcare needs to be strategized to ensure efficient utilization of resources.

• Item Type: MPRA Paper
• Language: English
• Keywords: Capitation; health outcomes; Referrals; Healthcare utilization
• Subjects: I - Health, Education, and Welfare > I0 - General; I - Health, Education, and Welfare > I1 - Health; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private

References

1. Barnum H, Kutzin J, Saxenian H. Incentives and provider payment methods. The International journal of health planning and management 1995;10(1):23-45.

2. Zuvekas SH, Hill SC. Does capitation matter? Impacts on access, use, and quality. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2004;41(3):316-35.

3. Andoh-Adjei F-X, Spaan E, Asante FA, et al. A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries. Ghana medical journal 2016;50(4):207-19.

4. Boachie MK. Healthcare provider‐payment mechanisms: a review of literature. J Behav Econ, Finance, Entrep, Account Transp 2014;2:41-46.

5. Mills A, Bennett S, Siriwanarangsun P, et al. The response of providers to capitation payment: a case-study from Thailand. Health Policy 2000;51(3):163-80.

6. Fowles JB, Weiner JP, Knutson D, et al. Taking health status into account when setting capitation rates: a comparison of risk-adjustment methods. Jama 1996;276(16):1316-21.

7. Jegers M, Kesteloot K, De Graeve D, et al. A typology for provider payment systems in health care. Health policy 2002;60(3):255-73.

8. Telyukov A. Guide to prospective capitation with illustrations from Latin America. LAC-Health Sector Reform Initiative 2001;5

9. Gold MR, Lake T, Hurley R, et al. Financial risk sharing with providers in health maintenance organizations, 1999. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2002;39(1):34-44.

10. Bloom JR, Hu Tw, Wallace N, et al. Mental health costs and access under alternative capitation systems in Colorado. Health Services Research 2002;37(2):315-40.

11. Eggleston K, Hsieh CR. Healthcare payment incentives: a comparative analysis of reforms in Taiwan, South Korea and China. Applied health economics and health policy 2004;3(1):47-56. [published Online First: 2005/02/11]

12. Yip W, Eggleston K. Provider payment reform in China: the case of hospital reimbursement in Hainan province. Health Economics 2001;10(4):325-39.

13. Warner R, Huxley P. Outcome for people with schizophrenia before and after Medicaid capitation at a community agency in Colorado. Psychiatric Services 1998;49(6):802-07.

14. Chalkley M, Tilley C. Treatment intensity and provider remuneration: dentists in the British National Health Service. Health economics 2006;15(9):933-46.

15. Murray JP, Greenfield S, Kaplan SH, et al. Ambulatory testing for capitation and fee-for-service patients in the same practice setting: relationship to outcomes. Medical Care 1992:252-61.

16. Ghana Health Service. Annual Report. Accra: Ghana Health Service 2007.

17. Ghana Health Service. The Health Sector in Ghana: Facts and Figures 2018. Accra: Ghana Health Service, 2018.

18. Léger PT. Quality control mechanisms under capitation payment for medical services. Canadian Journal of Economics/Revue canadienne d'économique 2000;33(2):564-86.

19. Gosden T, Forland F, Kristiansen I, et al. Capitation, salary, fee‐for‐service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database of Systematic Reviews 2000(3)

20. Lee-Feldstein A, Feldstein PJ, Buchmueller T, et al. The relationship of HMOs, health insurance, and delivery systems to breast cancer outcomes. Medical care 2000:705-18.

21. Cuffel BJ, R. Bloom J, Wallace N, et al. Two‐Year Outcomes of Fee‐for‐Service and Capitated Medicaid Programs for People with Severe Mental Illness. Health Services Research 2002;37(2):341-59.

22. Udvarhelyi IS, Jennison K, Phillips RS, et al. Comparison of the quality of ambulatory care for fee-for-service and prepaid patients. Annals of Internal Medicine 1991;115(5):394-400.

23. NHIA. Benefits Package [Available from: http://www.nhis.gov.gh/benefits.aspx accessed 02 November 2019.

24. Agyepong IA, Aryeetey GC, Nonvignon J, et al. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme–a systems approach. Health research policy and systems 2014;12(1):35.

25. Debpuur C, Dalaba MA, Chatio S, et al. An exploration of moral hazard behaviors under the national health insurance scheme in Northern Ghana: a qualitative study. BMC health services research 2015;15(1):469.

26. National Health Insurance Authority. Annual Report. Accra: National Health Insurance Authority 2009.

27. The implementation of the National Health Insurance Programme in Ghana–an institutional approach. 62nd Political Studies Association Annual International Conference in Defence of Politics; 2012.

28. Amporfu E. Private hospital accreditation and inducement of care under the ghanaian national insurance scheme. Health economics review 2011;1(1):13.

29. Bitran R, Yip WC. A review of health care provider payment reform in selected countries in Asia and Latin America. 1998

30. Atinga RA, Mensah SA, Asenso-Boadi F, et al. Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management. BMC health services research 2012;12(1):174.

31. Andoh-Adjei F-X, Cornelissen D, Asante FA, et al. Does capitation payment under national health insurance affect subscribers’ trust in their primary care provider? A cross-sectional survey of insurance subscribers in Ghana. BMC health services research 2016;16(1):437.

32. Owusu-Sekyere E, Bagah DA. Towards a sustainable health care financing in Ghana: Is the National Health Insurance the solution? Public Health Research 2014;4(5):185-94.

33. Nsowah-Adjei T. Commentary on the Challenges confronting the Implementation of The National Insurance Authority's Capitation in the Ashanti Region Accra: Ghana Broadcasting Corporation; 2012 [Available from: https://www.gbcghana.com/kitnes/data/2012/02/17/1.786483.txt accessed May 10 2012.

34. NHIA. NHIS suspends capitation program In Ashanti Region. . Accra: NHIA, 2017. 35. Andoh-Adjei F-X, Boudewijns B, Nsiah-Boateng E, et al. Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana. Health economics review 2018;8(1):17.

36. Opoku M, Nsiah R, Oppong P, et al. The effect of capitation payment on the national health insurance scheme in Ashanti Region, Ghana. Ghana (August 12, 2014) 2014

37. Agyei-Baffour P, Oppong R, Boateng D. Knowledge, perceptions and expectations of capitation payment system in a health insurance setting: a repeated survey of clients and health providers in Kumasi, Ghana. BMC Public Health 2013;13(1):1220.

38. Boachie MK. Preferred primary healthcare provider choice among insured persons in Ashanti Region, Ghana. International journal of health policy and management 2016;5(3):155.

39. Ghana Statistical Service. 2010 Population and Housing Census, Summary of Final Results. Accra, Ghana: Ghana Statistical Service 2012.

40. Ghana Health Service. Ashanti Half Year Report., 2010.

41. NHIA. Annual Report 2011

42. Yamane T. Statistics: An Introductory Analysis. 2 ed. New York: : Harper and Row' 1967.

43. Grossman M. On the concept of health capital and the demand for health. Journal of Political economy 1972;80(2):223-55.

44. Wagstaff A. The demand for health: theory and applications. Journal of Epidemiology & Community Health 1986;40(1):1-11.

45. Bossman E. An assessment on the effect of capitation on cost and utilization of health services: A case of the national health insurance authority of Ghana. NTNU, 2017.

46. Kazungu JS, Barasa EW, Obadha M, et al. What characteristics of provider payment mechanisms influence health care providers' behaviour? A literature review. The International journal of health planning and management 2018;33(4):e892-e905.