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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

Flowchart of steps taken in systematic review.Notes: aEMBASE: Excerpta Medica database.bCINAHL: Cumulative Index to Nursing and Allied Health Literature.cNHS EED: National Health Services Economic Evaluation Database.
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czs034-F2: Flowchart of steps taken in systematic review.Notes: aEMBASE: Excerpta Medica database.bCINAHL: Cumulative Index to Nursing and Allied Health Literature.cNHS EED: National Health Services Economic Evaluation Database.

Mentions: Figure 2 shows the different steps taken in the selection of articles for final review. We conducted full-text reviews of 99 articles. Thirty-four articles were included in the final review, which covered evidence on provider payment methods in 32 CBI schemes. With the exception of one article published in French (Criel et al. 2005), all articles included in the final review were published in English (see Table 3).Figure 2


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

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

Flowchart of steps taken in systematic review.Notes: aEMBASE: Excerpta Medica database.bCINAHL: Cumulative Index to Nursing and Allied Health Literature.cNHS EED: National Health Services Economic Evaluation Database.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

czs034-F2: Flowchart of steps taken in systematic review.Notes: aEMBASE: Excerpta Medica database.bCINAHL: Cumulative Index to Nursing and Allied Health Literature.cNHS EED: National Health Services Economic Evaluation Database.
Mentions: Figure 2 shows the different steps taken in the selection of articles for final review. We conducted full-text reviews of 99 articles. Thirty-four articles were included in the final review, which covered evidence on provider payment methods in 32 CBI schemes. With the exception of one article published in French (Criel et al. 2005), all articles included in the final review were published in English (see Table 3).Figure 2

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