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Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study

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  • Robyn, Paul Jacob
  • Bärnighausen, Till
  • Souares, Aurélia
  • Traoré, Adama
  • Bicaba, Brice
  • Sié, Ali
  • Sauerborn, Rainer

Abstract

In a community-based health insurance (CBHI) introduced in 2004 in Nouna health district, Burkina Faso, poor perceived quality of care by CBHI enrollees has been a key factor in observed high drop-out rates. The poor quality perceptions have been previously attributed to health worker dissatisfaction with the provider payment method used by the scheme and the resulting financial risk of health centers. This study applied a mixed-methods approach to investigate how health workers working in facilities contracted by the CBHI view the methods of provider payment used by the CBHI. In order to analyze these relationships, we conducted 23 in-depth interviews and a quantitative survey with 98 health workers working in the CBHI intervention zone. The qualitative in-depth interviews identified that insufficient levels of capitation payments, the infrequent schedule of capitation payment, and lack of a payment mechanism for reimbursing service fees were perceived as significant sources of health worker dissatisfaction and loss of work-related motivation. Combining qualitative interview and quantitative survey data in a mixed-methods analysis, this study identified that the declining quality of care due to the CBHI provider payment method was a source of significant professional stress and role strain for health workers. Health workers felt that the following five changes due to the provider payment methods introduced by the CBHI impeded their ability to fulfill professional roles and responsibilities: (i) increased financial volatility of health facilities, (ii) dissatisfaction with eligible costs to be covered by capitation; (iii) increased pharmacy stock-outs; (iv) limited financial and material support from the CBHI; and (v) the lack of mechanisms to increase provider motivation to support the CBHI. To address these challenges and improve CBHI uptake and health outcomes in the targeted populations, the health care financing and delivery model in the study zone should be reformed. We discuss concrete options for reform based on the study findings.

Suggested Citation

  • Robyn, Paul Jacob & Bärnighausen, Till & Souares, Aurélia & Traoré, Adama & Bicaba, Brice & Sié, Ali & Sauerborn, Rainer, 2014. "Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study," Social Science & Medicine, Elsevier, vol. 108(C), pages 223-236.
    • Handle: RePEc:eee:socmed:v:108:y:2014:i:c:p:223-236
    DOI: 10.1016/j.socscimed.2014.01.034
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    Cited by:

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    2. Laurene PETITFOUR & Xiezhe HUANGFU & Jacky MATHONNAT & Martine AUDIBERT, 2015. "Estimating and explaining the efficiency of township hospitals in Shandong province in the context of the drug policy reform," Working Papers 201517, CERDI.
    3. Bonfrer, Igna & Van de Poel, Ellen & Van Doorslaer, Eddy, 2014. "The effects of performance incentives on the utilization and quality of maternal and child care in Burundi," Social Science & Medicine, Elsevier, vol. 123(C), pages 96-104.
    4. Maren Duvendack, 2022. "Payment‐by‐results for health interventions in low‐ and middle‐income countries: A critical review," Development Policy Review, Overseas Development Institute, vol. 40(1), January.
    5. Laurene Petitfour & Xiezhe Huangfu & Martine Audibert & Jacky Mathonnat, 2015. "Estimating and explaining the efficiency of township hospitals in Shandong province in the context of the drug policy reform," Working Papers halshs-01180621, HAL.
    6. Hao‐Miao Li & Ying‐Chun Chen & Hong‐Xia Gao & Yan Zhang & Dai Su & Jing‐Jing Chang & Di Jiang & Xiao‐Mei Hu & Shi‐Han Lei, 2019. "Changes in inpatients' distribution and benefits under institution level–based quota payment for specific diseases in rural China: An interrupted time‐series analysis," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 436-446, January.

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