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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

Author

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  • Francis-Xavier Andoh-Adjei

    (National Health Insurance Authority, PMB Ministries Post Office)

  • Bronke Boudewijns

    (Radboud University Medical Centre-Netherlands)

  • Eric Nsiah-Boateng

    (National Health Insurance Authority, PMB Ministries Post Office)

  • Felix Ankomah Asante

    (Institute of Statistical, Social and Economic Research (ISSER) University of Ghana)

  • Koos van der Velden

    (Radboud University Medical Centre-Netherlands)

  • Ernst Spaan

    (Radboud University Medical Centre-Netherlands)

Abstract

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

Suggested Citation

  • Francis-Xavier Andoh-Adjei & Bronke Boudewijns & Eric Nsiah-Boateng & Felix Ankomah Asante & Koos van der Velden & Ernst Spaan, 2018. "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, Springer, vol. 8(1), pages 1-10, December.
    • Handle: RePEc:spr:hecrev:v:8:y:2018:i:1:d:10.1186_s13561-018-0203-9
    DOI: 10.1186/s13561-018-0203-9
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    References listed on IDEAS

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    2. Piotr Korneta & Magdalena Kludacz-Alessandri & Renata Walczak, 2021. "The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland," IJERPH, MDPI, vol. 18(4), pages 1-19, February.

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