Effects of capitation on utilization of healthcare: urinary tract infectious (UTI) patients: evidence of UTI patients of Komfo Anokye and Korle-Bu Teaching Hospitals Outpatient’s Department

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MAY, 2016
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Provider payment mechanism has influence on visits, referrals and quality of healthcare (utilization), which capitation healthcare payment is not an exception. As Fee For Service (FFS) payment system is characterized by inducement, Diagnostic Related Grouping (DRG) is attributed with a higher cost episode irrespective of the nature of care. This has resulted in diverse payment reforms to limit the healthcare providers from shopping to ensure efficient delivery of healthcare. The negative effects of these payments mechanisms have brought about a new payment system known as the capitation. Capitation was introduced in Ghana in 2010. It was however accompanied by series of demonstrations from pressure groups (Ashanti Development Union) and healthcare providers. As the providers claim it would reduce their profit margin the ADU thought it would affect utilization as stipulated by several studies. Using Poisson regression, ordered logistic regression and ordered binary regression, this research was primarily conducted to look into the adverse effect of capitation on utilization; visits, referrals, quality of healthcare and the willingness of patients to retain the primary care provider within a period of three months. A sample size of 500 NHIS Urinary Tract Infectious patients was selected with 250 each from Komfo Anokye Teaching Hospital (capitated group) and Korle-Bu Teaching Hospital (FFS/DRG group) was employed for the study. Some of the principal findings of the research using Poisson regression include; age was statistically significant with respect to visits as it had a positive correlation with visits, patients under capitation had less number of visits compared to patients under DRG/FFS (controlled group). However, using ordered logistic regression it was discovered that age impacted positively to quality of healthcare. Patients with a maximum education level of senior high school had positive relation with the quality of healthcare. On the other hand, patients under capitation had less quality of healthcare compared to patients under FFS or DRG (controlled group at Korle-Bu). The research discovered using binary logistic regression that patients under capitation are more likely to change their primary care provider, compared to those under the FFS/DRG payment system. Capitation impacted positively referrals compared to patients under FFS/DRG. This indicates there is a higher probability of being referred as patient under capitation compared to patients under FFS. In view of these findings, policy makers must ensure the populace is educated up to at least the secondary school level since secondary education impacted positively to the quality of healthcare. Secondly, the Ghana statistics service (GSS) must serve as an important point of reference to policy makers with policies associated with healthcare since female and age relate positively with visits. This indicates an ageing population or population with more females must equip itself with more health professional to cater for the increasing demand for healthcare. Finally, since capitation relates inversely with visits, quality of healthcare (compared to FFS/DRG) and positively on referrals (compared to the controlled group), policy makers must make sure there are inbuilt mechanism to check cream-skimming of patients to ensure adequate healthcare provision of healthcare to patients under capitation.
A thesis submitted to the School of Graduate Studies, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the award of the Degree of Master of Philosophy in Economics.