Private Hospital Accreditation and Inducement of care under the Ghanaian National Insurance Scheme

Presenter: Eugenia Amporfu, Kwame Nkrumah University of Science and Technology

Abstract

Rational: The introduction of the National Health Insurance Scheme (NHIS) in Ghana has allowed registered members to seek care at zero cost at the point of purchase. The resulting increase in utilization of care caused over-crowding in public and mission hospitals. This has necessitated the accreditation of private hospitals to ease the over-crowding in the public and mission hospitals. The government has also used demand side cost sharing measures to curb utilization rates. Thus policy to reduce utilization has ignored the supply side. Even though health care providers in the public and mission hospitals are salaried and so may not have the incentive to induce demand, physicians in private hospitals are paid directly by the NHIS under a fee for service scheme and so may have the incentive to induce demand.

Objectives: The goal of this paper is to find the extent to which the increase in utilization rates is caused by the supply side.

Methodology: Using the number of visits as the measure of quantity of care, with instrumental variable estimation in a Poisson model, the study used data on insured malaria out-patients in public, mission and private hospitals to find the extent to which utilization varied across hospital types. Propensity score method was also used to compare quantity of care of insured and uninsured patients.

Results: The results showed the presence of supply inducement especially in the private hospital. Utilization rates in general was higher among the insured than the uninsured regardless of hospital type, however, the difference was higher in the private hospitals.

Conclusions: The increase in utilization rates as a result of the NHIS is at least partly due to factors in the supply side. In the private hospitals where the physician is also the owner, the fee for service scheme under the NHIS creates incentive for inducement. Thus the cost per episode of illness is higher in the private hospitals than the public and mission hospitals. The paper recommends that the payment should be based episode of illness rather than services. Outcomes should be monitored in these private hospitals to ensure that quality is not compromised under the fee for episode of illness scheme.