title: Does capitation payment under national health insurance affect subscribers' trust in their primary care provider? a cross-sectional survey of insurance subscribers in Ghana.
abstract: Ghana introduced capitation payment for primary care in 2012 with the view to containing escalating claims expenditure. This shift in provider payment method raised issues about its potential impact on patient-provider trust relationship and insured-patients' trust in the Ghana National Health Insurance Scheme. This paper presents findings of a study that explored insured-patients' perception about, and attitude towards capitation payment in Ghana; and determined whether capitation payment affect insured-patients' trust in their preferred primary care provider and the National Health Insurance Scheme in general.
  
  
  
  We adopted a survey design for the study. We administered closed-ended questionnaires to collect data from insurance card-bearing members aged 18 years and above. We performed both descriptive statistics to determine proportions of observations relating to the variables of interest and chi-square test statistics to determine differences within gender and setting.
  
  
  
  Sixty-nine per cent (69 %) out of 344 of respondents selected hospital level of care as their primary care provider. The two most important motivations for the choice of a provider were proximity in terms of geographical access (40 %) and perceived quality of care (38 %). Eighty-eight per cent (88 %) rated their trust in their provider as (very) high. Eighty-two per cent (82 %) actively selected their providers. Eighty-eight per cent (88 %) had no intention to switch provider. A majority (91 %) would renew their membership when it expires. Female respondents (91 %; n = 281) were more likely to renew their membership than males (87 %; n = 63). Notwithstanding capitation payment experience, 81 % of respondents would recommend to their peers to enrol with the NHIS with rural dwellers (87 %; n = 156) being more likely to do so than urban dwellers (76 %; n = 188). Almost all respondents (92 %) rated the NHIS as (very) good.
  
  
  
  Health Insurance subscribers in Ghana have high trust in their primary care provider giving them quality care under capitation payment despite their negative attitude towards capitation payment. They are guided by proximity and quality of care considerations in their choice of provider. The NHIA would, however, have to address itself to the negative perceptions about the capitation payment policy.
authors.affiliation: , NHIA 36-6th Avenue, Ridge. PMB Ministries Post Office, Accra, Ghana. faxandoh@gmail.com.
authors.forename: Francis-Xavier
authors.identifier: 0000-0002-0874-3111
authors.initials: FX
authors.lastname: Andoh-Adjei
authors.affiliation: GROW-School of Oncology and Developmental Biology, Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre-The Netherlands, Maastricht, Netherlands.
authors.forename: Dennis
authors.initials: D
authors.lastname: Cornelissen
authors.affiliation: Institute of Statistical, Social and Economic Research (ISSER) University of Ghana, Legon-Accra, Ghana.
authors.forename: Felix Ankomah
authors.initials: FA
authors.lastname: Asante
authors.affiliation: Radboud Institute for Health Science, Department for Health Evidence, Radboud University Medical Center-Netherlands, Nijmegen, Netherlands.
authors.forename: Ernst
authors.initials: E
authors.lastname: Spaan
authors.affiliation: Radboud Institute for Health Science, Department for Primary and Community Health, Radboud University Medical Centre-Netherlands, Nijmegen, Netherlands.
authors.forename: Koos
authors.initials: K
authors.lastname: van der Velden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002204:Capitation Fee; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D005102:Health Expenditures; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data; D010465:Perception; D011320:Primary Health Care / Q000191:economics*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D035502:Trust; D055815:Young Adult
keywords: Capitation payment; Ghana; National health insurance; Primary care provider; Subscriber trust