A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries

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 providedand 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 evidencein their design of a context-specific capitation payment for primary care.Funding: Netherlands Fellowship Programme (NFP), Fellowship number: NFP-PhD.12/352Keywords: Capitation payment, primary care, cost-containment, national health insurance, Ghan

Built-in premium effects within exotic FX options

Purpose: This paper explains the analysis of built-in premium within ‘premium-free’ FX Option strategies, also known as ‘exotic options’. The aim is to analyse whether such an increase in built-in premium would have an effect on the outcome of the strategies. Methodology: The analysis was conducted through three different currency pairs, namely, the EURUSD, EURJPY and EURGBP, throughout a period between 2007 to 2014. The authors used the Bloomberg terminal to design two different option strategies: Window Forward Extra and At Expiry Forward Extra. These strategies are known as low risk hedging strategies within the FX options industry. The authors examined different combinations of changes in built-in premium and analysed the respective outcome with each combination. The outcomes were compared to analyse whether an increase in built-in premium would have an effect on the outcome of the strategy. A test was also conducted should these strategies be used as a speculative tool. The strategies were built on a 1 year tenor which is rolled over every month. Hence, each month a hedge using the strategy for 1 year was conducted. The authors used back dated implied volatilies when performing the back-testing in order for results to be realistic. Findings: In most cases it was found that there was no effect on the outcome of the strategy. However, this was only valid if an expiry at a time is taken. On the other hand, when taking into account the whole sample, even though only 3% of the times there was an effect on the outcome of the strategy, the total result finds that an increase in built-in premium has an effect on the outcome of the strategy. Such result was found to be statistically significant using a paired sample t-test. This applied for all currency pairs under review. When analysing the exotic option strategies for speculative purposes, the authors found that in most cases it would have been better for brokers to take higher risk and receive an upfront Premium.peer-reviewe

Transient Heat Conduction Through Heat Producing Layers. EUR 4818.

Subin sub-metro interview results – responses/statements from respondents in Subin sub-metro of the Ashanti region. (DOCX 29 kb

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

Contains fulltext : 190049.pdf (publisher's version ) (Open Access

Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana

Contains fulltext : 208048.pdf (publisher's version ) (Open Access

Does capitation payment under national health insurance affect subscribers' trust in their primary care provider? a cross-sectional survey of insurance subscribers in Ghana

Contains fulltext : 172339.pdf (publisher's version ) (Open Access

Correction: Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana.

[This corrects the article DOI: 10.1371/journal.pone.0221195.]

Does a provider payment method affect membership retention in a health insurance scheme? a mixed method study of Ghana's capitation payment for primary care

Abstract Background Ghana introduced a National Health Insurance Scheme (NHIS) in 2003 applying fee-for-service method for paying NHIS-credentialed health care providers. The National Health Insurance Authority (NHIA) later introduced diagnosis-related-grouping (DRG) payment to contain cost without much success. The NHIA then introduced capitation payment, a decision that attracted complaints of falling enrolment and renewal rates from stakeholders. This study was done to provide evidence on this trend to guide policy debate on the issue. Methods We applied mixed method design to the study. We did a trend analysis of NHIS membership data in Ashanti, Volta and Central regions to assess growth rate; performed independent-sample t-test to compare sample means of the three regions and analysed data from individual in-depth interviews to determine any relationship between capitation payment and subscribers’ renewal decision. Results Results of new enrolment data analysis showed differences in mean growth rates between Ashanti (M = 30.15, SE 3.03) and Volta (M = 40.72, SE 3.10), p = 0.041; r = 0. 15; and between Ashanti and Central (M = 47.38, SE6.49) p = 0.043; r = 0. 42. Analysis of membership renewal data, however, showed no significant differences in mean growth rates between Ashanti (M = 65.47, SE 6.67) and Volta (M = 69.29, SE 5.04), p = 0.660; r = 0.03; and between Ashanti and Central (M = 50.51, SE 9.49), p = 0.233. Analysis of both new enrolment and renewal data also showed no significant differences in mean growth rates between Ashanti (M = − 13.76, SE 17.68) and Volta (M = 5.48, SE 5.50), p = 0.329; and between Ashanti and Central (M = − 6.47, SE 12.68), p = 0.746. However, capitation payment had some effect in Ashanti compared with Volta (r = 0. 12) and Central (r = 0. 14); but could not be sustained beyond 2012. Responses from the in-depth interviews did not also show that capitation payment is a key factor in subscribers’ renewal decision. Conclusion Capitation payment had a small but unsustainable effect on membership growth rate in the Ashanti region. Factors other than capitation payment may have played a more significant role in subscribers’ enrolment and renewal decisions in the Ashanti region of Ghana

Additional file 1: of Does capitation payment under national health insurance affect subscribers’ trust in their primary care provider? a cross-sectional survey of insurance subscribers in Ghana

Household interview questionnaires. (DOCX 227 kb