141 lines
4.9 KiB
YAML
141 lines
4.9 KiB
YAML
abstract: 'Background: Small private providers in low- and middle-income countries
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(LMICs) are well positioned to fill gaps in services to low-income
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populations using Social Health Insurance (SHI) schemes. However, we
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know little about the practical challenges both private providers and
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patients face in the context of SHI that may ultimately limit access to
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quality services for low-income populations. In this paper, we pull
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together data collected from private providers, patients, and SHI
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officials in Kenya and Ghana to answer the question: does participation
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in an SHI scheme affect private providers'' ability to serve poorer
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patient populations with quality health services?
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Methods: In-depth interviews were held with 204 providers over three
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rounds of data collection (2013, 2015, 2017) in Kenya and Ghana. We also
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conducted client exit interviews in 2013 and 2017 for a total of 106
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patient interviews. Ten focus group discussions (FGDs) were conducted in
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Kenya and Ghana respectively in 2013 for a total of 171 FGD
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participants. A total of 13 in-depth interviews also were conducted with
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officials from the Ghana National Health Insurance Agency (NHIA) and the
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Kenya National Hospital Insurance Fund (NHIF) across four rounds of data
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collection (2013, 2014, 2016, 2017). Provider interviews covered reasons
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for (non) enrollment in the health insurance system, experiences with
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the accreditation process, and benefits and challenges with the system.
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Client exit interviews covered provider choice, clinic experience, and
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SHI experience. FGDs covered the local healthcare landscape. Interviews
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with SHI officials covered officials'' experiences working with private
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providers, and the opportunities and challenges they faced both
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accrediting providers and enrolling members. Transcripts were coded in
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Atlas.ti using an open coding approach and analyzed thematically.
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Results: Private providers and patients agreed that SHI schemes are
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beneficial for reducing out-of-pocket costs to patients and many
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providers felt they had to become SHI-accredited in order to keep their
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facilities open. The SHI officials in both countries corroborated these
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sentiments. However, due to misunderstanding of the system providers
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tended to charge clients for services they felt were above and beyond
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reimbursable expenses. Services were sometimes limited as well.
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Significant delays in SHI reimbursement in Ghana exacerbated these
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problems and compromised providers'' abilities to cover basic expenses
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without charging patients. While patients recognized the potential
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benefits of SHI coverage and many sought it out, a number of patients
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reported allowing their enrollment to lapse for cost reasons or because
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they felt the coverage was useless when they were still asked to pay for
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services out-of-pocket at the health facility.
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Conclusions: Our data point to several major barriers to SHI access and
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effectiveness for low-income populations in Ghana and in Kenya, in
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addition to opportunities to better engage private providers to serve
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these populations. We recommend using fee-for-service payments based on
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Diagnosis Related Group rather than a capitation payment system, as well
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as building more monitoring and accountability mechanisms into the SHI
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systems in order to reduce requests for informal out-of-pocket payments
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from patients while also ensuring quality of care. However, particularly
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in Ghana, these reforms should be accompanied by financial reform within
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the SHI system so that small private providers can be adequately funded
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through government financing.'
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affiliation: 'Suchman, L (Corresponding Author), Univ Calif San Francisco, Inst Global
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Hlth Sci, San Francisco, CA 94143 USA.
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Suchman, Lauren, Univ Calif San Francisco, Inst Global Hlth Sci, San Francisco,
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CA 94143 USA.'
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article-number: '179'
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author: Suchman, Lauren
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author-email: Lauren.Suchman@ucsf.edu
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author_list:
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- family: Suchman
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given: Lauren
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da: '2023-09-28'
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doi: 10.1186/s12939-018-0893-y
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eissn: 1475-9276
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files: []
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journal: INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH
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keywords: 'Social health insurance; Healthcare access; Private providers;
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Low-income; Kenya; Ghana'
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keywords-plus: 'DEVELOPING-COUNTRIES; COVERAGE; SECTOR; SCHEME; CARE; SERVICES;
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ACCOUNTABILITY; ENROLLMENT; AFRICA; ACCESS'
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language: English
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month: DEC 5
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number-of-cited-references: '72'
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orcid-numbers: Suchman, Lauren/0000-0002-3684-0314
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papis_id: a3002bce2095943b11c223004c3bd585
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ref: Suchman2018accreditingprivate
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times-cited: '9'
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title: 'Accrediting private providers with National Health Insurance to better serve
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low-income populations in Kenya and Ghana: a qualitative study'
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type: article
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unique-id: WOS:000452324900001
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usage-count-last-180-days: '1'
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usage-count-since-2013: '4'
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volume: '17'
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web-of-science-categories: Public, Environmental \& Occupational Health
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year: '2018'
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