Browsing by Author "Andoh-Adjei, F."
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Item Does capitation payment under national health insurance affect subscribers' trust in their primary care provider? a cross-sectional survey of insurance subscribers in Ghana.(2016) Andoh-Adjei, F.; Cornelissen, D.; Asante, A.F.; Spaan, E.; Velden, K.BACKGROUND: Ghana introduced capitation payment for primary care in 2012 with the view to containing escalating claims expenditure. This shift in provider payment method raised issues about its potential impact on patient-provider trust relationship and insured-patients' trust in the Ghana National Health Insurance Scheme. This paper presents findings of a study that explored insured-patients' perception about, and attitude towards capitation payment in Ghana; and determined whether capitation payment affect insured-patients' trust in their preferred primary care provider and the National Health Insurance Scheme in general. METHODS: We adopted a survey design for the study. We administered closed-ended questionnaires to collect data from insurance card-bearing members aged 18 years and above. We performed both descriptive statistics to determine proportions of observations relating to the variables of interest and chi-square test statistics to determine differences within gender and setting. RESULTS: Sixty-nine per cent (69 %) out of 344 of respondents selected hospital level of care as their primary care provider. The two most important motivations for the choice of a provider were proximity in terms of geographical access (40 %) and perceived quality of care (38 %). Eighty-eight per cent (88 %) rated their trust in their provider as (very) high. Eighty-two per cent (82 %) actively selected their providers. Eighty-eight per cent (88 %) had no intention to switch provider. A majority (91 %) would renew their membership when it expires. Female respondents (91 %; n = 281) were more likely to renew their membership than males (87 %; n = 63). Notwithstanding capitation payment experience, 81 % of respondents would recommend to their peers to enrol with the NHIS with rural dwellers (87 %; n = 156) being more likely to do so than urban dwellers (76 %; n = 188). Almost all respondents (92 %) rated the NHIS as (very) good. CONCLUSION: Health Insurance subscribers in Ghana have high trust in their primary care provider giving them quality care under capitation payment despite their negative attitude towards capitation payment. They are guided by proximity and quality of care considerations in their choice of provider. The NHIA would, however, have to address itself to the negative perceptions about the capitation payment policy.Item Knowledge and satisfaction of health insurance clients: a cross-sectional study in a tertiary hospital in Ghana(Journal of Public Health, 2019-11) Aikins, M.; Nsiah-Boateng, E.; Asenso-Boadi, F.; Andoh-Adjei, F.Aim This study assesses client knowledge of, and satisfaction with services under the National Health Insurance Scheme (NHIS) in a tertiary healthcare facility. Subject and methods A cross-sectional exit interview was conducted at the Korle-Bu Teaching Hospital in the Greater Accra region of Ghana. Respondents were classified into various groups based on the number of positive responses obtained for knowledge and satisfaction measures on a 5-point Likert scale. Descriptive statistics and multivariate logistic regression analyses were conducted to test and measure associations between client characteristics, their knowledge of the NHIS, and satisfaction with services. Results Two hundred and four clients participated in the study, representing a 97% response rate. Seventy-nine clients (39%) had more knowledge of the NHIS, 115 (56%) were more satisfied with NHIS services, and 200 (98%) were more satisfied with healthcare services. Factors including education and years of enrolment were significantly associated with more knowledge of the NHIS. Similarly, knowledge of the NHIS, number of living children, and years of enrolment strongly correlated with more satisfaction with NHIS services. However, being a returning patient was strongly related with less knowledge of the NHIS and less satisfaction with NHIS services. Conclusion Clients have less knowledge of the NHIS and are fairly satisfied with its services overall. However, they are more satisfied with healthcare provider services. More education and sensitization are necessary to increase knowledge and improve satisfaction and enrolment.Item A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries(2016) Andoh-Adjei, F.; Spaan, E.; Asante, A.F.; Mensah, A.S.; van der Velden, K.OBJECTIVE: To analyse and synthesize available international experiences and information on the motivation for, and effects of using capitation as provider payment method in country health systems and lessons and implications for low/middle-income countries. METHODS: We did narrative review and synthesis of the literature on the effects of capitation payment on primary care. RESULTS: Eleven articles were reviewed. Capitation payment encourages efficiency: drives down cost, serves as critical source of income for providers, promotes adherence to guidelines and policies, encourages providers to work better and give health education to patients. It, however, induces reduction in the quantity and quality of care provided and encourages skimming on inputs, underserving of patients in bad state of health, "dumping" of high risk patients and negatively affect patient-provider relationship. CONCLUSION: The illustrative evidence adduced from the review demonstrates that capitation payment in primary care can create positive incentives but could also elicit un-intended effects. However, due to differences in country context, policy makers in Ghana and other low/middle-income countries may only be guided by the illustrative evidence in their design of a context-specific capitation payment for primary care.