Is value-based payment for healthcare feasible under Ghana’s National Health Insurance Scheme?

Health Research Policy and Systems

Justice Nonvignon¹  Yussif Issahaku²  Gilbert Abotisem Abiiro³  Osondu Ogbouji⁴  Andrea Thoumi⁵ 

[1] Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana;Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana;Fuu D/A Junior High School, Ghana Education Service, Fuu, North East Gonja, Ghana;Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana;Fuu D/A Junior High School, Ghana Education Service, Fuu, North East Gonja, Ghana;Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA;Robert J. Margolis, MD, Center for Health Policy, Duke University, 1201 Pennsylvania Ave, NW, Suite 500, 20004, Washington DC, USA;Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA;

关键词: Feasibility;    Ghana;    Health financing;    National health insurance;    Value-based payment;   

DOI  :  10.1186/s12961-021-00794-y

来源: Springer

【 摘 要 】

BackgroundEffective payment mechanisms for healthcare are critical to the quality of care and the efficiency and responsiveness of health systems to meet specific population health needs. Since its inception, Ghana’s National Health Insurance Scheme (NHIS) has adopted fee-for-service, diagnostic-related groups and capitation methods, which have contributed to provider reimbursement delays, rising costs and poor quality of care rendered to the scheme’s clients. The aim of this study was to explore stakeholder perceptions of the feasibility of value-based payment (VBP) for healthcare in Ghana. Value-based payment refers to a system whereby healthcare providers are paid for the value of services rendered to patients instead of the volume of services.MethodsThis study employed a cross-sectional qualitative design. National-level stakeholders were purposively selected for in-depth interviews. The participants included policy-makers (n = 4), implementers (n = 5), public health insurers (n = 3), public and private healthcare providers (n = 7) and civil society organization officers (n = 1). Interviews were audio-recorded and transcribed. Data analysis was performed using both deductive and inductive thematic analysis. The data were analysed using QSR NVivo 12 software.ResultsGenerally, participants perceived VBP to be feasible if certain supporting systems were in place and potential implementation constraints were addressed. Although the concept of VBP was widely accepted, study participants reported that efficient resource management, provider motivation incentives and community empowerment were required to align VBP to the Ghanaian context. Weak electronic information systems and underdeveloped healthcare infrastructure were seen as challenges to the integration of VBP into the Ghanaian health system. Therefore, improvement of existing systems beyond healthcare, including public education, politics, data, finance, regulation, planning, infrastructure and stakeholder attitudes towards VBP, will affect the overall feasibility of VBP in Ghana.ConclusionValue-based payment could be a feasible policy option for the NHIS in Ghana if potential implementation challenges such as limited financial and human resources and underdeveloped health system infrastructure are addressed. Governmental support and provider capacity-building are therefore essential for VBP implementation in Ghana. Future feasibility and acceptability studies will need to consider community and patient perspectives.

【 授权许可】

CC BY