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Eugenia Amporfu Kwame Nkrumah University of Science and Technology, Ghana

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Private Hospital Accreditation and Inducement of Care under the Ghanaian National Health Insurance Scheme. Eugenia Amporfu Kwame Nkrumah University of Science and Technology, Ghana.

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slide1

Private Hospital Accreditation and Inducement of Care under the Ghanaian National Health Insurance Scheme

Eugenia Amporfu

Kwame Nkrumah University of Science and Technology, Ghana

slide2

An important concern of governments all over the world is how to provide good quality of health care at minimum cost.

  • Cost can increase as a result of increase in utilization of care.
slide3

Changes in utilization can be caused by the behaviors of both the consumer and the supplier of care.

  • The supplier can influence utilization through useful agency or by inducing demand.
slide4

Given the asymmetric information that exists between the physician and the patient, with the physician being better informed than the patient, the physician has influence on the quantity of health care that the patient consumes. If this influence moves a patient towards the optimal level of consumption we have useful agency (Fuchs, 1978).

slide5

Supplier induced demand (SID) in the

health care market refers to a

situation in which the physician

influences demand for his/her services in

a way, according to the physician’s

interpretation, that is not in the best

interest of the patient (McGuire, 2000).

slide6

The purpose of this paper is to use instrumental Poisson estimation to test for SID in the Ghanaian National Health Insurance Scheme (NHIS).

the nhis and the possibility of inducement
The NHIS and the Possibility of Inducement
  • The NHIS was initially valid only in public facilities and this led to overcrowding in the public facilities, as membership of the Scheme increased.
  • Private hospitals were therefore given accreditation to provide care to NHIS patients.
slide8

Physicians in private health facilities are paid on a fee for service basis leading to a positive relationship between output and income.

  • Physicians may have the incentive to induce service by the shifting of the demand curve to the right.
slide9

The study compares the demand functions of NHIS out patients with mild malaria in the public and private health facilities.

  • Quantity of care = number of visits during an episode of illness in the past year.
  • Data: hospital data from 2 private and 2 public hospitals in Kumasi, Ghana.
the model
The Model

A two stage estimation procedure is used. First stage: obtain predicted values for choice hospital by the logit estimation

Travel time was used as an instrument.

Second stage: Use Poisson regression:

conclusion
Conclusion
  • Inducement exists in the private hospitals for patients in the active age.
  • Number of visits increases 12.7 percent as a patient within the active age group moves from public to a private facility.
  • Physicians incur psychic cost from inducement.
slide14

For the young and the very old, private hospitals either induce by shifting the demand curve to the left or they ration care.

slide15

It is not clear how much cost is imposed on the NHIS because the increase in cost from inducement could be neutralized by the fall in cost due to rationing.

  • However, the patients are made worse off as a result of over utilization and under utilization depending on their age group.
policy recommendation
Policy Recommendation
  • Prospective payment scheme could be used for private hospitals.
  • Need to do more research in the area with more data.