Doctors say capitation is too low

Koforidua, Jan. 30, GNA – The Society of Private Medical and Dental Practitioners (SPMDP) Ghana has said they would not take part in the Capitation arrangement of payment for medical services as it exists in its present form.

“The Capitation rate is too low and will collapse the system,” they said.

Dr Kwasi Odoi-Agyarko, President of the Association, said at a press conference on Friday that Capitation-based reimbursement significantly influenced the practice of medicine and that “as physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk”.

He said a World Bank working paper No. 210 published in 2011 revealed among other things that access to private health care was increasing with 64% of those having an illness obtaining care in 2005-06, compared with 44 per cent in 1999.

“Users of all types of medical care across socio-economic status, geography, and sex, choose private providers for a substantial portion of their use of health services-in all cases, around 50 per cent of their use of services.”

The research also noted that National Health Insurance Scheme (NHIS) coverage appears to encourage consumers to use Ghana Health Service (GHS) services relative to privately provided services but this may be related to the incomplete accreditation of  Self Financing Private (SFP) providers.

“Consumers continue to spend money out-of pocket despite NHIS coverage and they do so at GHS, Christian Health Association of Ghana (CHAG), and SFP providers. NHIS coverage has increased the frequency with which consumers pay nothing at all. However, it has not changed the amount of out-of pocket spending in those cases when it is still required”.

Dr Odoi-Agyarko said global health facts and world health statistics published in 2011 showed that private expenditure on health as percent of total expenditure on health in Ghana is 48.4 and out-of- pocket expenditure as percent of private expenditure on health in Ghana is 79.3”.

He said the picture was already gloomy adding that under the new Capitation system the situation would go worse.

Dr Odoi-Agyarko said primary care physicians needed to work to assure that the capitation system incorporate checks and balances which protects both patients and providers.

He said as a payment model, capitation offered opportunities for primary care physicians to influence the future of health care by improving the management of resources at a local level.

Dr Odoi-Agyarko said as practicing physicians, their work demanded that they managed a number of concurrent risks.

“Our foremost responsibility is to manage the individual health risks of our patients, be they risks associated with lifestyle, predisposition to illness, or diagnosed conditions”.

“We also have a broader social responsibility to prudently use the resources civil society allocates to health care, civil society’s financial risk”.

Dr Odoi-Agyarko said Capitation affected all aspects of medical practice adding that it has the potential to clarify the boundaries between primary care physicians and their consulting sub-specialist colleagues.

He said it would certainly expand the financial risks faced by all practitioners adding “It will probably force changes in the allocation of health care resources, perhaps leading to a more accurate determination of true costs.

“Realistically, the necessary conditions for capitation to function as an acceptable and sustainable reimbursement model may never be achieved”.

“Our task is to actively participate in the re-engineering of health care delivery while maintaining our personal and professional standards in order to create a system that will work for everyone in our society”.

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