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Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana

INTRODUCTION: Ghana introduced capitation payment under National Health Insurance Scheme (NHIS), beginning with pilot in the Ashanti region, in 2012 with a key objective of controlling utilization and related cost. This study sought to analyse utilization and claims expenditure data before and after...

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Autores principales: Andoh-Adjei, Francis-Xavier, Boudewijns, Bronke, Nsiah-Boateng, Eric, Asante, Felix Ankomah, van der Velden, Koos, Spaan, Ernst
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111020/
https://www.ncbi.nlm.nih.gov/pubmed/30151701
http://dx.doi.org/10.1186/s13561-018-0203-9
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author Andoh-Adjei, Francis-Xavier
Boudewijns, Bronke
Nsiah-Boateng, Eric
Asante, Felix Ankomah
van der Velden, Koos
Spaan, Ernst
author_facet Andoh-Adjei, Francis-Xavier
Boudewijns, Bronke
Nsiah-Boateng, Eric
Asante, Felix Ankomah
van der Velden, Koos
Spaan, Ernst
author_sort Andoh-Adjei, Francis-Xavier
collection PubMed
description INTRODUCTION: Ghana introduced capitation payment under National Health Insurance Scheme (NHIS), beginning with pilot in the Ashanti region, in 2012 with a key objective of controlling utilization and related cost. This study sought to analyse utilization and claims expenditure data before and after introduction of capitation payment policy to understand whether the intended objective was achieved. METHODS: The study was cross-sectional, using a non-equivalent pre-test and post-test control group design. We did trend analysis, comparing utilization and claims expenditure data from three administrative regions of Ghana, one being an intervention region and two being control regions, over a 5-year period, 2010–2014. We performed multivariate analysis to determine differences in utilization and claims expenditure between the intervention and control regions, and a difference-in-differences analysis to determine the effect of capitation payment on utilization and claims expenditure in the intervention region. RESULTS: Findings indicate that growth in outpatient utilization and claims expenditure increased in the pre capitation period in all three regions but slowed in post capitation period in the intervention region. The linear regression analysis showed that there were significant differences in outpatient utilization (p = 0.0029) and claims expenditure (p = 0.0003) between the intervention and the control regions before implementation of the capitation payment. However, only claims expenditure showed significant difference (p = 0.0361) between the intervention and control regions after the introduction of capitation payment. A difference-in-differences analysis, however, showed that capitation payment had a significant negative effect on utilization only, in the Ashanti region (p < 0.007). Factors including availability of district hospitals and clinics were significant predictors of outpatient health care utilization. CONCLUSION: We conclude that outpatient utilization and related claims expenditure increased in both pre and post capitation periods, but the increase in post capitation period was at slower rate, suggesting that implementation of capitation payment yielded some positive results. Health policy makers in Ghana may, therefore, want to consider capitation a key provider payment method for primary outpatient care in order to control cost in health care delivery. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13561-018-0203-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-61110202018-09-20 Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana Andoh-Adjei, Francis-Xavier Boudewijns, Bronke Nsiah-Boateng, Eric Asante, Felix Ankomah van der Velden, Koos Spaan, Ernst Health Econ Rev Research INTRODUCTION: Ghana introduced capitation payment under National Health Insurance Scheme (NHIS), beginning with pilot in the Ashanti region, in 2012 with a key objective of controlling utilization and related cost. This study sought to analyse utilization and claims expenditure data before and after introduction of capitation payment policy to understand whether the intended objective was achieved. METHODS: The study was cross-sectional, using a non-equivalent pre-test and post-test control group design. We did trend analysis, comparing utilization and claims expenditure data from three administrative regions of Ghana, one being an intervention region and two being control regions, over a 5-year period, 2010–2014. We performed multivariate analysis to determine differences in utilization and claims expenditure between the intervention and control regions, and a difference-in-differences analysis to determine the effect of capitation payment on utilization and claims expenditure in the intervention region. RESULTS: Findings indicate that growth in outpatient utilization and claims expenditure increased in the pre capitation period in all three regions but slowed in post capitation period in the intervention region. The linear regression analysis showed that there were significant differences in outpatient utilization (p = 0.0029) and claims expenditure (p = 0.0003) between the intervention and the control regions before implementation of the capitation payment. However, only claims expenditure showed significant difference (p = 0.0361) between the intervention and control regions after the introduction of capitation payment. A difference-in-differences analysis, however, showed that capitation payment had a significant negative effect on utilization only, in the Ashanti region (p < 0.007). Factors including availability of district hospitals and clinics were significant predictors of outpatient health care utilization. CONCLUSION: We conclude that outpatient utilization and related claims expenditure increased in both pre and post capitation periods, but the increase in post capitation period was at slower rate, suggesting that implementation of capitation payment yielded some positive results. Health policy makers in Ghana may, therefore, want to consider capitation a key provider payment method for primary outpatient care in order to control cost in health care delivery. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13561-018-0203-9) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2018-08-27 /pmc/articles/PMC6111020/ /pubmed/30151701 http://dx.doi.org/10.1186/s13561-018-0203-9 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Andoh-Adjei, Francis-Xavier
Boudewijns, Bronke
Nsiah-Boateng, Eric
Asante, Felix Ankomah
van der Velden, Koos
Spaan, Ernst
Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana
title Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana
title_full Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana
title_fullStr Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana
title_full_unstemmed Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana
title_short Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana
title_sort effects of capitation payment on utilization and claims expenditure under national health insurance scheme: a cross-sectional study of three regions in ghana
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111020/
https://www.ncbi.nlm.nih.gov/pubmed/30151701
http://dx.doi.org/10.1186/s13561-018-0203-9
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