Abiiro Gilbert Abotisem
Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana.
Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana.
PLOS Glob Public Health. 2024 May 30;4(5):e0003265. doi: 10.1371/journal.pgph.0003265. eCollection 2024.
Capitation as a provider payment mechanism gained policy attention by the Ghana National Health Insurance Scheme (NHIS) in 2012 and was piloted in the Ashanti Region, Ghana. Recent studies revealed that the policy was suspended in 2017 due to inappropriate policy framing, actor contestations, unclear policy design characteristics, and an unfavorable political context. However, the NHIS still has interest in capitation as a provider payment option. Using the modified political process model, a prospective policy analysis was conducted to explore how to: i) appropriately reframe policy debates; ii) create political opportunities; and iii) mobilize resources to reattract policy attention to capitation in Ghana. Cross-sectional qualitative data were gathered in December, 2019 from semi-structured interviews with a purposive sample of 18 stakeholders and complemented with four community-level focus group discussions with 41 policy beneficiaries in the pilot region. All data were tape-recorded and transcribed. The analysis was thematic, using the NVivo 12 software. The results revealed that an appropriate reframing of the policy requires policy renaming, refinement of certain policy design characteristics (emergency care, capitation rates, choice and assignment of providers) and refocusing policy communication and advocacy on the health benefits of capitation instead of its cost containment intent. To create political opportunities for policy re-implementation, a politically sensitive approach with broader stakeholder consultations should be adopted. Policy advocacy and communication should be evidenced-based and led by politically neutral agents. An equitable capitation policy implementation requires resourcing health facilities, especially the lower-level facilities, with improved infrastructure, consumables, improved information management systems and well-trained personnel to enhance their service delivery capacities. The study concludes that there exists stakeholder interest in the capitation policy in Ghana and calls for an effective reframing, creation of political opportunities, and mobilization of needed resources to regain policy attention.
人头付费作为一种医疗服务提供者支付机制，在2012年受到加纳国家医疗保险计划（NHIS）的政策关注，并在加纳阿散蒂地区进行了试点。最近的研究表明，由于政策框架不当、行为主体争议、政策设计特征不明确以及不利的政治环境，该政策于2017年被暂停。然而，NHIS仍然对人头付费作为一种医疗服务提供者支付选项感兴趣。利用改进后的政治过程模型，进行了一项前瞻性政策分析，以探讨如何：i）恰当地重新构建政策辩论；ii）创造政治机会；iii）调动资源，重新吸引加纳对人头付费政策的关注。2019年12月，通过对18名利益相关者的目的抽样进行半结构化访谈收集了横断面定性数据，并在试点地区与41名政策受益者进行了四次社区层面的焦点小组讨论作为补充。所有数据都进行了录音和转录。使用NVivo 12软件进行了主题分析。结果表明，对政策进行适当的重新构建需要重新命名政策、完善某些政策设计特征（急诊护理、人头费率、医疗服务提供者的选择和分配），并将政策沟通和宣传的重点重新放在人头付费对健康的益处上，而不是其成本控制意图上。为了为政策重新实施创造政治机会，应采用一种具有更广泛利益相关者协商的政治敏感方法。政策宣传和沟通应以证据为基础，并由政治中立的机构牵头。公平的人头付费政策实施需要为医疗机构，特别是基层医疗机构提供资源，改善基础设施、消耗品、完善信息管理系统并配备训练有素的人员，以提高其服务提供能力。该研究得出结论，加纳的利益相关者对人头付费政策存在兴趣，并呼吁进行有效的重新构建、创造政治机会以及调动所需资源以重新获得政策关注。
