IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v8y2018i1d10.1186_s13561-018-0203-9.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-018-0203-9
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-018-0203-9?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Rosen, Bruce, 1989. "Professional reimbursement and professional behavior: Emerging issues and research challenges," Social Science & Medicine, Elsevier, vol. 29(3), pages 455-462, January.
    2. Mills, Anne & Bennett, Sara & Siriwanarangsun, Porntep & Tangcharoensathien, Viroj, 2000. "The response of providers to capitation payment: a case-study from Thailand," Health Policy, Elsevier, vol. 51(3), pages 163-180, April.
    3. De Jaegher, Kris & Jegers, Marc, 2000. "A model of physician behaviour with demand inducement," Journal of Health Economics, Elsevier, vol. 19(2), pages 231-258, March.
    4. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
    5. Yip, Winnie & Eggleston, Karen, 2004. "Addressing government and market failures with payment incentives: Hospital reimbursement reform in Hainan, China," Social Science & Medicine, Elsevier, vol. 58(2), pages 267-277, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Gordon Abekah-Nkrumah & Maxwell Antwi & Alex Yao Attachey & Wendy Janssens & Tobias F Rinke de Wit, 2022. "Readiness of Ghanaian health facilities to deploy a health insurance claims management software (CLAIM-it)," PLOS ONE, Public Library of Science, vol. 17(10), pages 1-17, October.
    2. Osei Afriyie, Doris & Loo, Pei Shan & Kuwawenaruwa, August & Kassimu, Tani & Fink, Günther & Tediosi, Fabrizio & Mtenga, Sally, 2024. "Understanding the role of the Tanzania national health insurance fund in improving service coverage and quality of care," Social Science & Medicine, Elsevier, vol. 347(C).
    3. Adolf Kwadzo Dzampe & Shingo Takahashi, 2024. "Financial incentives and health provider behaviour: Evidence from a capitation policy in Ghana," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), pages 333-344, February.
    4. 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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Francis-Xavier Andoh-Adjei & Eric Nsiah-Boateng & Felix Ankomah Asante & Koos van der Velden & Ernst Spaan, 2019. "Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-13, August.
    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.
    3. Maurus Rischatsch & Maria Trottmann & Peter Zweifel, 2013. "Generic substitution, financial interests, and imperfect agency," International Journal of Health Economics and Management, Springer, vol. 13(2), pages 115-138, June.
    4. Faden, Laura & Vialle-Valentin, Catherine & Ross-Degnan, Dennis & Wagner, Anita, 2011. "Active pharmaceutical management strategies of health insurance systems to improve cost-effective use of medicines in low- and middle-income countries: A systematic review of current evidence," Health Policy, Elsevier, vol. 100(2), pages 134-143.
    5. Erin Johnson & M. Marit Rehavi & David C. Chan, Jr & Daniela Carusi, 2016. "A Doctor Will See You Now: Physician-Patient Relationships and Clinical Decisions," NBER Working Papers 22666, National Bureau of Economic Research, Inc.
    6. Innocenti, Federico & McCormick, Barry & Nicodemo, Catia, 2025. "Gatekeeping in primary care: Analysing GP referral patterns and specialist consultations in the NHS," Economic Modelling, Elsevier, vol. 142(C).
    7. Pierre-Thomas Léger & Erin C. Strumpf, 2010. "Système de paiement des médecins : bref de politique," CIRANO Project Reports 2010rp-12, CIRANO.
    8. Seema Kacker & Tin Aung & Dominic Montagu & David Bishai, 2021. "Providers preferences towards greater patient health benefit is associated with higher quality of care," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 271-294, September.
    9. Lise Rochaix, 2004. "Les modes de rémunération des médecins," Revue d'Économie Financière, Programme National Persée, vol. 76(3), pages 223-239.
    10. Tianyan Hu & Sandra L. Decker & Shin-Yi Chou, 2014. "The Impact of Health Insurance Expansion on Physician Treatment Choice: Medicare Part D and Physician Prescribing," NBER Working Papers 20708, National Bureau of Economic Research, Inc.
    11. Moscone, Francesco & Siciliani, Luigi & Tosetti, Elisa & Vittadini, Giorgio, 2020. "Do public and private hospitals differ in quality? Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 83(C).
    12. Kevin E. Pflum, 2015. "Physician Incentives and Treatment Choice," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 24(4), pages 712-751, October.
    13. Calub, Renz Adrian, 2014. "Physician quality and payment schemes: A theoretical and empirical analysis," MPRA Paper 66038, University Library of Munich, Germany.
    14. Barros, Pedro Pita, 2003. "Cream-skimming, incentives for efficiency and payment system," Journal of Health Economics, Elsevier, vol. 22(3), pages 419-443, May.
    15. Wagstaff, Adam & Yu, Shengchao, 2007. "Do health sector reforms have their intended impacts?: The World Bank's Health VIII project in Gansu province, China," Journal of Health Economics, Elsevier, vol. 26(3), pages 505-535, May.
    16. Kümpel, Christian & Schneider, Udo, 2020. "Additional reimbursement for outpatient physicians treating nursing home residents reduces avoidable hospital admissions: Results of a reimbursement change in Germany," Health Policy, Elsevier, vol. 124(4), pages 470-477.
    17. Guccio, C. & Lisi, D., 2014. "Social interactions in inappropriate behavior for childbirth services: Theory and evidence from the Italian hospital sector," Health, Econometrics and Data Group (HEDG) Working Papers 14/28, HEDG, c/o Department of Economics, University of York.
    18. Müller, Tobias & Schmid, Christian & Gerfin, Michael, 2023. "Rents for Pills: Financial incentives and physician behavior," Journal of Health Economics, Elsevier, vol. 87(C).
    19. Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Policy Analysis in Health-Services Market: Accounting for Quality and Quantity," Annals of Economics and Statistics, GENES, issue 91-92, pages 293-319.
    20. Jasmin Kantarevic & Boris Kralj, 2016. "Physician Payment Contracts in the Presence of Moral Hazard and Adverse Selection: The Theory and Its Application in Ontario," Health Economics, John Wiley & Sons, Ltd., vol. 25(10), pages 1326-1340, October.

    More about this item

    Keywords

    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:hecrev:v:8:y:2018:i:1:d:10.1186_s13561-018-0203-9. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.