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Provider payment in community-based health insurance schemes in developing countries: a systematic review.

Robyn PJ, Sauerborn R, Bärnighausen T - Health Policy Plan (2012)

Bottom Line: Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries.Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance.The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention.

View Article: PubMed Central - PubMed

Affiliation: Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. jakerobyn@gmail.com

ABSTRACT

Objectives: Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance.

Methods: We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010.

Results: Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme.

Conclusion: CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic.

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Related in: MedlinePlus

Community-based health insurance (CBI) provider payment methods and CBI outcomes.
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czs034-F1: Community-based health insurance (CBI) provider payment methods and CBI outcomes.

Mentions: CBI is a mechanism to generate financial resources for the health system. Just like in other types of insurance (such as private, for-profit or social insurance), provider payment methods can influence provider and patient behaviour in CBI and thus contribute to ensuring that sufficient funds are raised and that the limited funds are used efficiently (Bennett 2004). First, provider payment methods can affect provider satisfaction with a CBI and health worker participation and retention. Second, it is plausible that payment methods influence how far health workers encourage people in their communities to join the CBI. Health workers who are satisfied with the way the CBI pays them are more likely to support CBI and encourage their patients to enrol in such insurance schemes. Third, payment methods might affect population enrolment in a CBI both directly (e.g. through the level of patient copayments for health care) and indirectly (e.g. through their impact on the quantity and quality of health care services provided for CBI enrolees). Figure 1 shows hypothesized pathways from provider payment methods to CBI outcomes; Table 1 shows hypotheses based on the literature about the effect of provider payment mechanisms on CBI ability to contain costs and the capacity for financial planning.Figure 1


Provider payment in community-based health insurance schemes in developing countries: a systematic review.

Robyn PJ, Sauerborn R, Bärnighausen T - Health Policy Plan (2012)

Community-based health insurance (CBI) provider payment methods and CBI outcomes.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3584992&req=5

czs034-F1: Community-based health insurance (CBI) provider payment methods and CBI outcomes.
Mentions: CBI is a mechanism to generate financial resources for the health system. Just like in other types of insurance (such as private, for-profit or social insurance), provider payment methods can influence provider and patient behaviour in CBI and thus contribute to ensuring that sufficient funds are raised and that the limited funds are used efficiently (Bennett 2004). First, provider payment methods can affect provider satisfaction with a CBI and health worker participation and retention. Second, it is plausible that payment methods influence how far health workers encourage people in their communities to join the CBI. Health workers who are satisfied with the way the CBI pays them are more likely to support CBI and encourage their patients to enrol in such insurance schemes. Third, payment methods might affect population enrolment in a CBI both directly (e.g. through the level of patient copayments for health care) and indirectly (e.g. through their impact on the quantity and quality of health care services provided for CBI enrolees). Figure 1 shows hypothesized pathways from provider payment methods to CBI outcomes; Table 1 shows hypotheses based on the literature about the effect of provider payment mechanisms on CBI ability to contain costs and the capacity for financial planning.Figure 1

Bottom Line: Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries.Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance.The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention.

View Article: PubMed Central - PubMed

Affiliation: Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. jakerobyn@gmail.com

ABSTRACT

Objectives: Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance.

Methods: We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010.

Results: Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme.

Conclusion: CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve performance, and how such effects could be assessed with scientific rigour to increase the strength of evidence on this topic.

Show MeSH
Related in: MedlinePlus