Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana

Document Type : Original Article

Author

Department of Economics, Annamalai University, Annamalai Nagar, TN, India

Abstract

Background
In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP.
 
Methods
Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome.
 
Results
Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level.
 
Conclusion
Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels by ensuring constant availability of essential drugs, doctors, and shorter waiting time. However, individual enrolees may value each criterion differently. Thus, not all enrolees may be motivated by same concerns. This requires providers to be circumspect regarding the factors that may attract enrolees. The National Health Insurance Authority (NHIA) should also ensure timely release of funds to help providers procure the necessary medical supplies to ensure quality service.

Keywords

Main Subjects

References

  1. Annemarie VW, Hester J. Patient choice of providers in a preferred provider organization. Medical Care. 1988;26:3:240-255.  doi:10.1097/00005650-198803000-00002
  2. Appleby J, Harrison A, Devlin N. What is the Real Cost of More Patient Choice? London: The King’s Fund; 2003. http://www.kingsfund.org.uk/publications/what-real-cost-more-patient-choice. Accessed March 25, 2014.
  3. Ranerup A, Noren L, Sparud-Lundin C. Decision support systems for choosing a primary health care provider in Sweden. Patient Educ Couns. 2012;86(3):342-347.doi:10.1016/j.pec.2011.06.013
  4. Dixon A, Robertson R, Bal R. The experience of implementing choice at point of referral: a comparison of the Netherlands and England. Health Econ Policy Law. 2010;5:295-317. doi:10.1017/S1744133110000058
  5. Sorensen AT. Insurer-hospital bargaining: negotiated discounts in post-deregulated Connecticut. J Ind Econ. 2003;51:469-490. doi:10.1111/j.0022-1821.2003.00211.x
  6. Schwartz LM, Woloshin S, Birkmeyer JD. How do elderly patients decide where to go for major surgery? Telephone interview survey. BMJ. 2005;331(7520):821-824. doi:10.1136/bmj.38614.449016.de
  7. Montefiori M. Spatial competition for quality in the market for hospital care. Eur J Health Econ. 2005;6:131-135. doi:10.1007/s10198-004-0268-8
  8. Varkevisser M, van der Geest SA. Why do patients bypass the nearest hospital? An empirical analysis for orthopaedic care and neurosurgery in the Netherlands. Eur J Health Econ. 2007; 8(3):287-295. doi:10.1007/s10198-006-0035-0
  9. Varkevisser M, van der Geest SA, Schut FT. Assessing hospital competition when prices don't matter to patients: the use of time-elasticities.  Int J Health Care Finance Econ.2010;10(1):43-60. doi:10.1007/s10754-009-9070-6
  10. Atinga AR, Mensah SA, Asenso-Boadi F, Andoh-Adjei F. Migrating from user fees to social health insurance: exploring the prospects and challenges for hospital management. BMC Health Serv Res 2012;12:174. doi:10.1186/1472-6963-12-174
  11. Boachie MK. Effects of Capitation on the Health Outcomes of Malaria Patients: Evidence from Ashanti and Brong Ahafo Regions of Ghana [MPhil (Economics) Thesis]. Kumasi, Ghana: Department of Economics, Kwame Nkrumah University of Sci & Tech; 2013.
  12. Dodoo JN. A stakeholder analysis of the capitation pilot under Ghana’s National Health Insurance Scheme in the Ashanti Region [MPH Thesis]. Ghana: School of Public Health, University of Ghana; 2013.
  13. Opoku M, Nsiah R, Oppong PA, Tetteh E. The effect of capitation payment on the national health insurance scheme in Ashanti Region, Ghana. School of Business, Kwame Nkrumah University of Science and Technology, Kumasi; 2014.
  14. Rapid Appraisal of Capitation Payment in Ashanti Region: Kumasi. Ghana Health Service; [n.d].
  15. Hirschman AO. Exit, Voice, and Loyalty: Responses to Decline in Firms, Organizations, and States. Cambridge, MA: Harvard University Press; 1970.
  16. Naasegnibe K, Dary SK. Choice of healthcare providers among insured persons in Ghana. Research on Humanities and Social Sciences. 2012;2(10):88-97.
  17. Dzator J, Asafu-Adjaye J. A study of malaria care provider choice in Ghana.  Health Policy. 2004;69(3):389-401.
  18. Amaghionyeodiwe LA. Determinants of the choice of healthcare provider in Nigeria. Health Care Manage Sci. 2008;11:215-227. doi:10.1007/s10729-007-9038-3
  19. Adaman F, Ardiç OP, Erus B, Tüzemen D. Hospital choice: survey evidence from Istanbul. Turkish Studies. 2009;10(3):443-468.doi:10.1080/14683840903141780
  20. Bour D. Determinants of utilisation of health services by women in rural and urban areas in Ghana. GeoJournal. 2004;61:89-102. doi:10.1007/s10708-005-1929-6
  21. White WD, Morrisey MA. Are patients travelling further? Int J Econ Bus. 1998; 5:203-221.
  22. Tai WC, Porell FW, Adams EK. Hospital choice of rural Medicare beneficiaries: patient, hospital attributes, and the patient-physician relationship. Health Serv Res. 2004;39:1903-1922.
  23. Sofaer S, Crofton C, Goldstein E, Hoy E, Crabb J. What do consumers want to know about the quality of care in hospitals? Health Serv Res. 2005;40:2018-2036. doi:10.1111/j.1475-6773.2004.00324.x
  24. Chul-Young R, Keon-Hyung L. Hospital choice by rural Medicare beneficiaries: does hospital ownership matter? A Colorado case. J Health Hum Serv Adm.2005; 28(3):346-365.
  25. 2010 Census Final Report. Ghana Statistical Service; 2012.
  26. NHIA Annual Report. Accra; 2012.
  27. Yamane T. Statistics: An Introductory Analysis. 2nded. New York: Harper and Row’ 1967.

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History

  • Receive Date: 19 April 2015
  • Revise Date: 16 October 2015
  • Accept Date: 16 October 2015
  • First Publish Date: 01 March 2016

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