title: Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana.
abstract: Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghana's National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts.
authors.affiliation: Department of Geography, Social Science Centre, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A5C2, Canada katuoye@uwo.ca.
authors.forename: Kilian Nasung
authors.initials: KN
authors.lastname: Atuoye
authors.affiliation: Department of Geography, Social Science Centre, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A5C2, Canada.
authors.forename: Siera
authors.initials: S
authors.lastname: Vercillo
authors.affiliation: Department of Geography, Social Science Centre, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A5C2, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Antabe
authors.affiliation: FIDS, University for Development Studies, Tamale, Ghana.
authors.forename: Sylvester Zackaria
authors.initials: SZ
authors.lastname: Galaa
authors.affiliation: Department of Geography, Social Science Centre, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A5C2, Canada.
authors.forename: Isaac
authors.initials: I
authors.lastname: Luginaah
mesh_terms: D002204:Capitation Fee; D003625:Data Collection; D005380:Financing, Government / Q000191:economics*; D005869:Ghana; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*; D011050:Policy Making; D011787:Quality of Health Care
keywords: Capitation; Content analysis; Ghana; Policy; health; health insurance