wow-inequalities/02-data/intermediate/wos_sample/c50e0b6fbe4d20b00dfca5c6bad7ac1d-suchman-lauren/info.yaml

abstract: 'Background: Small private providers in low- and middle-income countries

  (LMICs) are well positioned to fill gaps in services to low-income

  populations using Social Health Insurance (SHI) schemes. However, we

  know little about the practical challenges both private providers and

  patients face in the context of SHI that may ultimately limit access to

  quality services for low-income populations. In this paper, we pull

  together data collected from private providers, patients, and SHI

  officials in Kenya and Ghana to answer the question: does participation

  in an SHI scheme affect private providers'' ability to serve poorer

  patient populations with quality health services?

  Methods: In-depth interviews were held with 204 providers over three

  rounds of data collection (2013, 2015, 2017) in Kenya and Ghana. We also

  conducted client exit interviews in 2013 and 2017 for a total of 106

  patient interviews. Ten focus group discussions (FGDs) were conducted in

  Kenya and Ghana respectively in 2013 for a total of 171 FGD

  participants. A total of 13 in-depth interviews also were conducted with

  officials from the Ghana National Health Insurance Agency (NHIA) and the

  Kenya National Hospital Insurance Fund (NHIF) across four rounds of data

  collection (2013, 2014, 2016, 2017). Provider interviews covered reasons

  for (non) enrollment in the health insurance system, experiences with

  the accreditation process, and benefits and challenges with the system.

  Client exit interviews covered provider choice, clinic experience, and

  SHI experience. FGDs covered the local healthcare landscape. Interviews

  with SHI officials covered officials'' experiences working with private

  providers, and the opportunities and challenges they faced both

  accrediting providers and enrolling members. Transcripts were coded in

  Atlas.ti using an open coding approach and analyzed thematically.

  Results: Private providers and patients agreed that SHI schemes are

  beneficial for reducing out-of-pocket costs to patients and many

  providers felt they had to become SHI-accredited in order to keep their

  facilities open. The SHI officials in both countries corroborated these

  sentiments. However, due to misunderstanding of the system providers

  tended to charge clients for services they felt were above and beyond

  reimbursable expenses. Services were sometimes limited as well.

  Significant delays in SHI reimbursement in Ghana exacerbated these

  problems and compromised providers'' abilities to cover basic expenses

  without charging patients. While patients recognized the potential

  benefits of SHI coverage and many sought it out, a number of patients

  reported allowing their enrollment to lapse for cost reasons or because

  they felt the coverage was useless when they were still asked to pay for

  services out-of-pocket at the health facility.

  Conclusions: Our data point to several major barriers to SHI access and

  effectiveness for low-income populations in Ghana and in Kenya, in

  addition to opportunities to better engage private providers to serve

  these populations. We recommend using fee-for-service payments based on

  Diagnosis Related Group rather than a capitation payment system, as well

  as building more monitoring and accountability mechanisms into the SHI

  systems in order to reduce requests for informal out-of-pocket payments

  from patients while also ensuring quality of care. However, particularly

  in Ghana, these reforms should be accompanied by financial reform within

  the SHI system so that small private providers can be adequately funded

  through government financing.'
affiliation: 'Suchman, L (Corresponding Author), Univ Calif San Francisco, Inst Global
  Hlth Sci, San Francisco, CA 94143 USA.

  Suchman, Lauren, Univ Calif San Francisco, Inst Global Hlth Sci, San Francisco,
  CA 94143 USA.'
article-number: '179'
author: Suchman, Lauren
author-email: Lauren.Suchman@ucsf.edu
author_list:
- family: Suchman
  given: Lauren
da: '2023-09-28'
doi: 10.1186/s12939-018-0893-y
eissn: 1475-9276
files: []
journal: INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH
keywords: 'Social health insurance; Healthcare access; Private providers;

  Low-income; Kenya; Ghana'
keywords-plus: 'DEVELOPING-COUNTRIES; COVERAGE; SECTOR; SCHEME; CARE; SERVICES;

  ACCOUNTABILITY; ENROLLMENT; AFRICA; ACCESS'
language: English
month: DEC 5
number-of-cited-references: '72'
orcid-numbers: Suchman, Lauren/0000-0002-3684-0314
papis_id: a3002bce2095943b11c223004c3bd585
ref: Suchman2018accreditingprivate
times-cited: '9'
title: 'Accrediting private providers with National Health Insurance to better serve
  low-income populations in Kenya and Ghana: a qualitative study'
type: article
unique-id: WOS:000452324900001
usage-count-last-180-days: '1'
usage-count-since-2013: '4'
volume: '17'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2018'