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.
Health Res Policy Syst. 2021 Dec 11;19(1):145. doi: 10.1186/s12961-021-00794-y.
Effective 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.
This 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.
Generally, 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.
Value-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.
有效的医疗保健支付机制对于医疗保健的质量以及卫生系统满足特定人群健康需求的效率和响应能力至关重要。自成立以来，加纳的国家健康保险计划（NHIS）一直采用按服务收费、诊断相关分组和人头付费方法，这导致了提供者报销延迟、成本上升和向该计划客户提供的医疗服务质量下降。本研究旨在探讨利益相关者对加纳基于价值的医疗保健支付（VBP）可行性的看法。基于价值的支付是指一种系统，根据该系统，医疗服务提供者根据向患者提供的服务的价值而不是服务量获得报酬。
本研究采用了横断面定性设计。国家一级的利益相关者被有目的地选为深入访谈对象。参与者包括政策制定者（n=4）、实施者（n=5）、公共健康保险公司（n=3）、公共和私人医疗保健提供者（n=7）和民间社会组织官员（n=1）。访谈进行了录音和转录。使用演绎和归纳主题分析进行数据分析。数据使用 QSR NVivo 12 软件进行分析。
一般来说，如果有适当的支持系统和潜在的实施限制得到解决，参与者认为 VBP 是可行的。尽管 VBP 的概念得到了广泛的认可，但研究参与者报告说，需要有效的资源管理、提供者激励措施和社区赋权，以使 VBP 与加纳的情况保持一致。电子信息系统薄弱和医疗基础设施欠发达被视为将 VBP 纳入加纳卫生系统的挑战。因此，除了医疗保健之外，对现有系统的改进，包括公共教育、政治、数据、金融、监管、规划、基础设施以及利益相关者对 VBP 的态度，将影响 VBP 在加纳的总体可行性。
如果解决潜在的实施挑战，如有限的财务和人力资源以及欠发达的卫生系统基础设施，VBP 可能是加纳 NHIS 的可行政策选择。因此，政府的支持和提供者能力建设对于加纳的 VBP 实施至关重要。未来的可行性和可接受性研究需要考虑社区和患者的观点。
