Department of Community Medicine and Global Health, University of Oslo, Postboks 1130, Blindern, Oslo, 0318, Norway.
African Population and Health Research Center, Nairobi, Kenya.
BMC Health Serv Res. 2023 Aug 11;23(1):853. doi: 10.1186/s12913-023-09885-8.
The Government of The Gambia introduced a national health insurance scheme (NHIS) in 2021 to promote universal health coverage (UHC). Provider payment systems (PPS) are strategic purchasing arrangements that can enhance provider performance, accountability, and efficiency in the NHIS. This study assessed healthcare workers' (HCWs') preferences for PPS across major service areas in the NHIS.
A facility-based cross-sectional study was conducted using a probability proportionate to size sampling technique to select an appropriate sample size. Health care workers were presented with options for PPS to choose from across major service areas. Descriptive statistics explored HCW socio-demographic and health service characteristics. Multinomial logistic regressions were used to assess the association between these characteristics and choices of PPS.
The majority of HCW did not have insurance coverage, but more than 60% of them were willing to join and pay for the NHIS. Gender, professional cadre, facility level, and region influenced HCW's preference for PPS across the major service areas. The preferred PPS varied among HCW depending on the service area, with capitation being the least preferred PPS across all service areas.
The National Health Insurance Authority (NHIA) needs to consider HCW's preference for PPS and factors that influence their preferences when choosing various payment systems. Strategic purchasing decisions should consider the incentives these payment systems may create to align incentives to guide provider behaviour towards UHC. The findings of this study can inform policy and decision-makers on the right mix of PPS to spur provider performance and value for money in The Gambia's NHIS.
冈比亚政府于 2021 年推出了国家健康保险计划（NHIS），以促进全民健康覆盖（UHC）。提供者支付系统（PPS）是战略采购安排，可以提高 NHIS 中提供者的绩效、问责制和效率。本研究评估了医疗保健工作者（HCWs）在 NHIS 主要服务领域对 PPS 的偏好。
采用概率比例与大小抽样技术进行基于机构的横断面研究，以选择适当的样本量。向医疗保健工作者提供 PPS 选择，涵盖主要服务领域。描述性统计数据探索了 HCW 的社会人口统计学和卫生服务特征。使用多项逻辑回归评估这些特征与 PPS 选择之间的关联。
大多数 HCW 没有保险覆盖，但超过 60%的人愿意加入并为 NHIS 付费。性别、专业干部、机构级别和地区影响 HCW 在主要服务领域对 PPS 的偏好。根据服务领域的不同，HCW 对 PPS 的偏好也有所不同，在所有服务领域中，人头费是最不受欢迎的 PPS。
国家健康保险管理局（NHIA）在选择各种支付系统时，需要考虑 HCW 对 PPS 的偏好以及影响他们偏好的因素。战略采购决策应考虑这些支付系统可能产生的激励措施，以将激励措施与 UHC 保持一致，指导提供者的行为。本研究的结果可以为冈比亚 NHIS 的支付系统提供正确的组合，以刺激提供者的绩效和物有所值，为政策制定者和决策者提供信息。
