Association between Healthcare Provider Payment Systems and Health Outcomes in Ghana

Different payment systems generate different incentives for patients, providers, and purchasers. This study uncovers the effect of provider-payment methods on patient health outcomes, utilization of healthcare services and referral patterns in Ghana. Using data on 250 enrollees of the National Health Insurance Scheme (NHIS) from each payment plan (i.e., capitation and Diagnosis Related Groupings/fee-for-service plans), ordered logit, negative binomial and logit regression results showed that patients under capitation were 4.6% less likely to report better health and had 29% fewer visits relative to patients under DRG/FFS. In relation to referrals, capitated providers were more likely to refer patients than under DRG/FFS plans. Better health outcomes were reported by patients of private health facilities. Capitation in Ghana led to under-provision of care and cost-shifting, hence decreasing any efficiency gain from the reform. Purchasing of healthcare needs to be strategized to ensure efficient utilization of resources