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

1
Private Hospital Accreditation and Inducement of
Care under the Ghanaian National Health Insurance
Scheme

• Eugenia Amporfu
• Kwame Nkrumah University of Science and
  Technology, Ghana

2

• 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.

3

• 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.

4

• 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).

5

• 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 physicians
• interpretation, that is not in the best
• interest of the patient (McGuire, 2000).

6

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

7
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.

8

• 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.

9

• 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.

10
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

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Data Description
Public Private Total
Sample Age Gender Male Female Affluence Rich Poor No. of Visits 1587 2.5 60 40 82 18 2.06 458 2.1 45.2 54.8 78.6 21.4 1.32 2045 2.4 40.9 59.1 81.7 18.3 1.89
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Table 3 Results from Poisson Regressions
Estimated Coefficients Estimated Coefficients (with interaction)
Gender Age Residential Travel time to choice hospital Private Hospital Active age group Interaction of active age and private hospital Constant 0.684 (0.00) 0.019 (0.00) 1.59 (0.00) 0.01 (0.00) -0.981 (0.00) -1.45 (0.00) 0.028 0.003 0.001 -0.592 -0.036 0.127 0.589
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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.

14

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

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• 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.

16
Policy Recommendation

• Prospective payment scheme could be used for
  private hospitals.
• Need to do more research in the area with more
  data.

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• THANK YOU