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. 2018 Mar 7;19(1):37.
doi: 10.1186/s12875-018-0727-4.

Perception of quality health care delivery under capitation payment: a cross-sectional survey of health insurance subscribers and providers in Ghana

Francis-Xavier Andoh-Adjei  1 , Eric Nsiah-Boateng  2 , Felix Ankomah Asante  3 , Ernst Spaan  4 , Koos van der Velden  5
Affiliations

Perception of quality health care delivery under capitation payment: a cross-sectional survey of health insurance subscribers and providers in Ghana

Francis-Xavier Andoh-Adjei et al. BMC Fam Pract. .

Abstract

Background: Ghana introduced capitation payment method in 2012 but was faced with resistance for its perceived poor quality of care. This paper assesses National Health Insurance Scheme subscribers and care providers' perception of quality of care under the capitation payment method.

Methods: This is a cross-sectional survey of subscribers and care providers perception of quality of care in three administrative regions of Ghana using a 5-point Likert scale for the assessment based on a set of quality of care measures. We performed descriptive analysis to determine average perception of quality of care scores for each of the measures used. Bivariate and multivariate analyses were also performed to examine relationships between respondent's characteristics and their perception of quality of care.

Results: In general, subscribers expressed positive perception about the quality of care though subscribers in Ashanti were less positive compared to those in the Central region. A chi-square analysis, however, showed significant differences in subscribers' perception of quality of care by occupation (p = 0.002), region (p = 0.007) length of NHIS membership (p = 0.006), and age (p = 0.014). Multivariate logistic regression analysis also showed that different factors, other than region of residence, were significantly associated with perceived good quality of care. Analysis of health care providers' responses also showed significant differences in their perception of quality of care by region (p = 0.001). Multivariate logistic model showed that health care providers in the Volta region (OR = 0.14, 95% CI: 0.03-0.58) were significantly less likely to perceive quality of care as good compared to those in the Ashanti region.

Conclusion: Subscribers and care providers across the three regions have relatively good perception of the quality of health care in general though subscribers in Ashanti were less positive than those in the Central region. It is, therefore, plausible that capitation payment may have influenced the relatively low perception of quality of care in the Ashanti region.

Keywords: Capitation payment; Ghana; Health care providers; Health insurance subscribers; Perceived quality of care.

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Conflict of interest statement

Authors’ information

FAX (MSc. MPH) is an employee at the National Health Insurance Authority, Accra-Ghana. ENB (MSc. MPH) is an employee at the National Health Insurance Authority, Accra-Ghana. ES (PhD) is an Assistant Professor of International Public Health at the Radboud University Medical Centre-Radboud Institute for Health Sciences in Nijmegen, Netherlands. FAA (PhD) is the Director for the Institute of Statistical Social and Economic Research at the University of Ghana-Legon, Accra-Ghana. KvdV (PhD) is Professor of Public Health at the Radboud University Medical Centre-Radboud Institute for Health Sciences, Nijmegen.

Ethics approval and consent to participate

We obtained ethical approval for the study (certified protocol number: UG-ECH 057/13–14) from the University of Ghana Institute of Statistical, Social and Economic Research (ISSER) Ethics Committee for Humanities (ECH) after we had sought official permission from the office of the Director-General of the Ghana Health Service (approval letter dated 18/02/2014) to use the NHIS-credentialed health care providers for the study. Participation in the study was optional, and the right to respondents’ privacy was guaranteed with the signing of informed consent by respondents and interviewer.

Consent for publication

Not applicable.

Competing interests

FAX and ENB are employees of NHIA. However, since results from the study are meant to help improve the policy intervention under consideration, their relationship with the organization does not influence the results. All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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