PART TWO

SUBSCRIBER(HOUSEHOLD)INTERVIEWS

Titleof Study: / ProviderpaymentreformswithintheNationalHealthInsuranceScheme:
MonitoringandEvaluationofCapitationasaproviderpaymentmechanism forprimaryout-patients services.
PrincipalInvestigator: / Francis-Xavier Andoh-Adjei
Certified Protocol Number / UG-ECH 057/13-14

Section B– CONSENTTO PARTICIPATEINRESEARCH

General Informationabout Research

Weareconductingastudyontheimplementationofcapitationasaproviderpayment mechanisminordertoassessitseffectonhealthservicedeliveryattheprimaryout-patient departmentofNHIS-credentialedfacilitiesandtoexploreNHIScardbearers’perceptionof qualityofserviceandhowthatperceptioninfluencetheirinsurancemembershipstatusand healthseekingbehavior.Weshallneedaboutonehourofyourtimetorespondtosome questions that wewill askyou for answers.

Benefits/Risk ofthestudy

The resultsofthestudywillhelpthe NationalHealthInsuranceAuthoritytoimproveits operations forthe benefitof all stakeholdersand the nation as a whole.

Confidentiality

Weshallnot disclosetheidentityofanyperson whorespondstoourquestionsorwhoprovideus withanyinformationthatwillhelpusinthisresearch.Namesofpersonswhorespondtoour questionswillnotbewritteninanyofourreportsorarticlesthatwillbepublishedfor international consumption.

Apartfromtheuniversityauthoritiesandtheresearchteam,nootherpersonswillhaveaccessto theresearchrecords.Thefinalresults,whichwillbeintheformofareport,willhoweverbe sharedwithallstakeholders,thatistheNHIA,providersandsubscribersatNHISstakeholders’ forum.Articleswillalsobepreparedfromthereportsandpublishedininternationalpeer-review journals.

Compensation

This is an academicstudyintended to help NHIAimproveon its operationsforthebenefit ofthe entiresocietyandthereforetherewillnotbeanyincentivewhatsoeverforpeoplewhovolunteer to respond to the questions that weshall ask.

WithdrawalfromStudy

Yourparticipationinthisstudyisvoluntaryandyouarefreetowithdrawfromthestudyoreven refusetoansweranyquestionifyouwishandnobodywillfault youforyourdecisionto withdraw from the studyor yourrefusal to answer anyquestion.

Contact forAdditionalInformation

Incaseyouhaveanyquestionsorinformationaboutthisresearchthatyoumaywanttoconvey tous,youmaydirectthemtothefollowing:Francis-XavierAndoh-Adjei,HeadofPlanning, MonitoringEvaluationandInternationalRelations,NationalHealthInsurance Authority,36-6thAvenue,Ridge,PMB,MinistriesPostOffice,Accra.Youcanalsoreach himon telephonenumbers: 024 461 3747 or020 923 4905.

Section C-VOLUNTEER AGREEMENT

"Ihavereadorhavehadsomeonereadalloftheabove,askedquestions,receivedanswers regardingparticipationinthisstudy,andamwillingtogiveconsentforme,mychild/ward toparticipateinthisstudy.Iwillnothavewaivedanyofmyrightsbysigningthisconsent form. Uponsigning thisconsent form, I will receive a copy formy personal records."

Name ofVolunteer:

Signatureor mark ofvolunteerDate

Ifvolunteers cannot read theformthemselves,a witness must sign here:

Iwaspresentwhilethebenefits,risksandprocedureswerereadtothevolunteer.Allquestions were answered and thevolunteer has agreed to takepart in theresearch.

Name ofwitness

Signatureof witnessDate

Icertifythatthenatureandpurpose,thepotentialbenefits,andpossiblerisksassociatedwith participatingin this research havebeenexplained to the aboveindividual.

Nameof Research Assistant

Signatureof Research AssistantDate

INDENTIFICATION

NAMEOFRESPONDENT:...... /
GENDER:(MALE=1,FEMALE=2)
TELEPHONENUMBER:......
REGION:(ASHANTI=1,VOLTA=2,CENTRAL=3)
DISTRICT: ......
ENUMERATIONAREABASENAME…………………………………………
URBAN/RURAL(URBAN=1,RURAL=2)
COMMUNITY(CITY=1,LARGETOWN=2,SMALLTOWN=3VILLAGE=4)
LANGUAGEOFQUESTIONNAIRES:ENGLISH
LANGUAGEOFINTERVIEWLANGUAGEOFRESPONDENT
WASTRANSLATORUSED?(YES=1,NO=2)
***LANGUAGECODES:(ENGLISH=1,AKAN=2,GA=3,EWE=4,NZEMA=5,
DAGBANI=6, OTHER=7)......
SPECIFY /
NAMEOFRESEARCHASSISTANT / SIGNATURE / DATE

DAY
MONTHRESULTS
NAMEOFSUPERVISOR / SIGNATURE /
DAY
MONTH
RESULTS
RESULTSCODES:COMPLETED=1,PARTIALLYCOMPLETED=2,REFUSED3,OTHER=4…………………
(SPECIFY)
SECTION1:RESPONDENT’SBASICSOCIO-DEMOGRAPHICS
IwouldliketoasksomequestionsaboutyourselfandIshallbegratefulforyouranswers.
NO. / QUESTIONSFILTERS / CODINGCATEGORIES
1. / Howold were you atyour last birthday? / AGEINCOMPLETEYEARS /
2. / Whatis yourmaritalstatus? / 1.Nevermarried
2.Married
3.Separated
4.Divorced
5.Widowed
6.Cohabitating /
3. / Whatisthehighestlevelof schoolyou attended? / 1.Primary
2.Middle/JSS
3.Secondary/SSS
4.Higher
5.Neverattendedschool /
4. / Whatis youremployment status? / 1.Governmentemployee
2.Non-governmentemployee
3.Self-employed
4.Non-paid(volunteer)
5. Student
6.Home-maker
7.Retiree
8. Unemployed/(abletowork) /
5. / Duringthelast12 months,what has been yourmain occupation?
NOTE:
Main occupationrefers to workonwhichrespondent spentmost of his/her timeor earned him/her themost income duringthe pastyear. / 1.Seniorofficial/manager
2.Professional (engineer, doctor,teacher,etc)
3.Technician
4.Service/sales worker
5.Agric. /fisheryworker
6.Plant/machine operator/assembler
7.Elementaryworker (street Food vendor, etc)
8.Other[specify]:………….. /
6. / Howlonghave you been a registered memberofthe NHIS? / 1.<1year
2.1-2years
3.2-3years
4.3-5years
5.5years /

Subscriber questionnaires

SECTION2:SUBSCRIBERHEALTHCAREUTILIZATION
Now, Iwould liketo ask you about your healthcareutilization.
7. Howmanytimes didyougo for treatment duringthe pastyear (2013)? /
  1. ONETIME
  2. TWOTIMES
  3. THREETIMES
  4. MORETHAN3TIMES
  5. NONEATALL

8. Whenwasthelasttime thatyou neededhealth care and you wentto a healthfacilityfor treatment? /
  1. 1-3MONTHSAGO
  2. 4-6MONTHSAGO
  3. 7-9MONTHSAGO
  4. 10-12MONTHSAGO
  5. MORETHAN12MONTHSAGO

9. Whichtype ofhealthfacilitydid you go fortreatmentthe lasttime? /
  1. CHPSCOMPOUND
  2. MATERNITYHOME
  3. HEALTHCENTER
  4. CLINIC
  5. HOSPITAL

10. Thefacility you visitedthelast time is operated by /
  1. GOVERNMENT
  2. PRIVATE
  3. MISSION
  4. OTHER(SPECIFY)
  5. …………………………….

11. Is the facilityyou visited lasttime the place where you alwaysgo for treatment? /
  1. Yes
  2. NO

12. Which of the followinghealth care personnelattendedto you? /
  1. MEDICALDOCTOR(includinganyspecialist)
  2. MEDICALASSISTANT
  3. NURSE
  4. MIDWIFE
  5. COMMUNITYHEALTHNURSE
  6. HEALTHASSISTANT
  7. OTHER (SPECIFY)…………………………....

13. Howlongdidittake foryou to be seen bythe prescriber? /
  1. < 15MINS
  2. 15-30 MINS
  3. 31-45 MINS
  4. 46-60 MINS
  5. 60 MINS

14. Howmuch time did thePrescriber spend with you in theconsultingroom? /
  1. < 5 MINS
  2. 5-10 MINS
  3. 10-15 MINS
  4. > 15MINS

15. Whatailmentdid you take to the facilityfor treatmentduring your last visit? / Name ofailment:

Subscriber questionnaires

16. Were you referred tothe laboratoryfor investigationduring your lastvisit? /
  1. YES
  2. NO(If“NO” , go to17)

17. Did you do allorsome ofthe laboratorytestatthefacility? /
  1. YES, ALL
  2. YES, SOME
  3. NO, NONE ATALL

18.Have you everbeenreferred to any privatelaboratoryfortests thatyou think couldhave beendoneinthe facility? /
  1. YES
  2. NO

19. Didthe Doctor/Nurseprescribe medicinesfor you? /
  1. YES
  2. NO(If “NO”goto22)

20. Did you receive allthemedicines prescribedfor youin the facility? /
  1. YES, ALL
  2. YES, SOME
  3. NO, NOTATALL

21. Howwould you ratethemedicinesthat were prescribedand given to you? /
  1. VERYGOOD
  2. GOOD
  3. BAD
  4. VERY BAD

22. Did you have topayany moneyatthe facility? /
  1. YES
  2. NO(If“NO”, go to24)

23. Howmuchmoneydid you payatlast visitforanyof the following, if applicable? /
  1. LABORATORY:GH¢………….…………
  1. MEDICINES:GH¢………………………..
  1. OTHER:GH¢ ……………………….

Total / GH¢……………………….
24. Have you everbeenreferred to another (levelcare)facilityfortreatmentthatyou thinkcould have been handled at this facility? /
  1. YES
  2. NO

25. In the last12 months thatyou have had experience withthe provider, howwould you rate yoursatisfaction withservices providedto you? /
  1. VERYGOOD
  2. GOOD
  3. BAD
  4. VERY BAD

Subscriber questionnaires

SECTION3:SUBSCRIBERPERCEPTIONOFQUALITYOFCARE-GENERAL

Now,Iwouldliketofindoutyouropinionaboutcareprovisioninthefacilitywhereyougofortreatment(inreferencetoyourlastvisittothefacility)andIshallbegrateful foryourresponses.Theopinionsareexpressedinstatementsandyourresponsewillbetostronglyagree,agree,disagreeorstronglydisagreewiththestatementinthefollowingrankings:

Stronglyagree(4)Agree(3)Dis-agree(2)Stronglydis-agree(1)Don’tknow (8)
Staff availability & prompt attention
26. / There was a prescriber availableto attend to me. / 4 / 3 / 2 / 1 / 8
/
27. / I was abletoseetheprescriberwithin30
mins. / 4 / 3 / 2 / 1 / 8
/
Dignity andrespect
28. / The Nurses were courteoustowards me. / 4 / 3 / 2 / 1 / 8
/
29. / The Nursestreated me withdignity. / 4 / 3 / 2 / 1 / 8
/
Confidentiality
30. / Theconsultingroomwas such thatwhen I was tellingmyconditiontothe Doctor / Nurse, no oneelse could hearme. / 4 / 3 / 2 / 1 / 8
/
31. / Thenurses keepclients’ health information secretand confidential. / 4 / 3 / 2 / 1 / 8
/
Service quality
32. / Theprescribermade a gooddiagnosis when I wentfortreatment thelasttime. / 4 / 3 / 2 / 1 / 8
/
33. / The treatmentIgotfromtheprescriber was effective for recoveryand cure. / 4 / 3 / 2 / 1 / 8
/
34. / Themedicinesthatwereprescribed for me were very good forthe ailment. / 4 / 3 / 2 / 1 / 8
/

Subscriber questionnaires

Communication
35. / Theprescribermade time to discussmy health condition and the required treatment with me. / 4 / 3 / 2 / 1 / 8
/
36. / He/Sheexplained everythingaboutthe treatmentto mebeforeIleft. / 4 / 3 / 2 / 1 / 8
/
37. / He/sheadvisedme on the side effects of treatmentthatheprescribedforme. / 4 / 3 / 2 / 1 / 8
/
38. / He/Shespenttime to adviseme on preventive care. / 4 / 3 / 2 / 1 / 8
/
39. / He/Sheopenedupto mefor questionsabout thetreatments/he gave. / 4 / 3 / 2 / 1 / 8
/
Autonomy
40. / Theprescribergave me the option toaccept or torefuse the treatments/he prescribed for me. / 4 / 3 / 2 / 1 / 8
/
Accommodation/cleanliness
41. / Thelasttime Ivisited the facility, theseats at the waitingarea wereenough to seat everybodywho came for treatment. / 4 / 3 / 2 / 1 / 8
/
42. / Duringmylastvisittothe facility, the environment, includingthetoiletfacilities, wasneat. / 4 / 3 / 2 / 1 / 8
/
43. / Duringmylastvisit,there wasno congestion atthe healthfacility. / 4 / 3 / 2 / 1 / 8
/
44. / Duringmylastvisittothe facility, the waitingarea was wellventilated. / 4 / 3 / 2 / 1 / 8
/

Subscriber questionnaires

SECTION4:KNOWLEDGEANDPERCEPTIONABOUTCAPITATION

Now,Iwould like to find outyour knowledge aboutcapitation and why you chosea particularprovider as your preferred primarycareprovider (PPP).
Question / Response / Response
code
45. Do you knowaboutcapitation? / 1.YES
2. NO[If“NO”goto45] /
46. Howdid you getto knowof capitation? / 1.SCHEMESTAFF
2.PROVIDER
3.RADIO
4.TELEVISION
5.COLLEAGUE
6.OTHER(SPECIFY)……………………………. /
47. Which of the followingstatements expresses your understandingof capitation? / 1.ADVANCEPAYMENTTOPROVIDERSFORALLOPDSERVICES
2.ADVANCEPAYMENTTOPROVIDERSFORSOMEOPDSERVICES
3.ADVANCEPAYMENTTOPROVIDERSFORBOTHOPDANDIPDSERVICES
4.DON’T KNOW /
Capitationand choiceofPPP(Notapplicable to Volta and Central)
48. Did you understandtheconceptof capitation before itwasimplemented? / 1.YES
2. NO /
49. Do you have a Preferred Primary
Care Provider(PPP)? / 1.YES
2.NO /
50. Which one of the followingis your Preferred PrimaryProvider(PPP)? / 1.CHPSCOMPOUND
2.MATERNITYHOME
3.HEALTHCENTER(GOVERNMENT)
4.HEALTHCENTER(PRIVATE/MISSION)
5.CLINIC(GOVERNMENT)
6.CLINICPRIVATE/MISSION)
7.HOSPITAL(GOVERNMENT)
8.HOSPITAL(PRIVATE/MISSION)
9. OTHER(SPECIFY)
………………………………. /
51. Did you choosethe PPP yourself? /
  1. YES
  2. NO,ASSIGNEDBYSCHEME
  3. NO,ASSIGNEDONATTENDANCEAT
FACILITY (If2or3,goto50 ) /
52. Whatis your mainreason for choosingthatprovideras your (PPP)? /
  1. CLOSENESSTOME
  2. PROVIDEGOODTREATMENT
  3. GOODATTITUDEOFSTAFF
  4. NOOTHERALTERNATIVE
  5. OTHER(SPECIFY)
….…………………………………. /
53. Whatdo you understand by choosinga PPP? /
  1. CHOOSE3AND ATTENDANYOFTHEM
WHENSICK.
  1. CHOOSE3BUT ATTENDONLYONEWHENSICK.
  2. CHOOSE3ANDATTENDANYONEDEPENDINGONTHEHEALTHCONDITION.
  3. DON’TUNDERSTANDIT.
/
54. Howlongdo you thinkone should stay withhis/herPPP before (s) he changes if (s)he wantsto? /
  1. 3MONTHS
  2. 6MONTHS
  3. 9MONTHS
  4. 12MONTHS
  5. ANYTIMEONEWANTSTOCHANGE
  6. DON’TKNOW
/
Now,Iwould like to find outyourexperience of, andopinion aboutyourpreferred primarycare provideronaspectsoftheir services and Ishallbe gratefulforyour responses.Theseare expressedinstatementsand your response willbetostronglyagree, agree,disagreeorstronglydis-agree withthe statementin the follow rankings: (NOTAPPLICABLE TOVOLTAANDCENTRAL)
Strongly agree(4)Agree(3) Dis-agree (3) Strongly dis-agree (2)Don’t know(8)
Perceivedreason(s) behind capitation
55. / Capitationis meanttodrivedown costof health caretoa reasonable level. / 4 / 3 / 2 / 1 / 8
/
56. / Capitationis meanttoimprove the qualityof care. / 4 / 3 / 2 / 1 / 8
/
57. / Capitationis meantto punish the peoplein
Ashantiregion. / 4 / 3 / 2 / 1 / 8
/
58. / Capitation was broughttoAshantibecause of politics. / 4 / 3 / 2 / 1 / 8
/
Responsivenessunder capitation
59. / If one has notenrolled withanyproviderand
(s)he goes fortreatment,theyenrollhim/her on thespotandprovidethetreatmentneeded / 4 / 3 / 2 / 1 / 8
/
60. / If one has notenrolled withanyproviderandhe goes fortreatment,theyaskhim/herto payfor the costoftreatment. / 4 / 3 / 2 / 1 / 8
/
61. / If one is on capitation, (s)he pays extra moneyfor the treatment(s)he gets. / 4 / 3 / 2 / 1 / 8
/
Perceivedeffects of capitation
62. / Capitationis contributingto the death of people in Ashantiregion. / 4 / 3 / 2 / 1 / 8
/
63. / Capitationiscausingfrustration tothe insuredatthe healthfacilities. / 4 / 3 / 2 / 1 / 8
/
64. / Since Capitationstarted,providersto refer potentialprimarycare cases to higherlevels of care. / 4 / 3 / 2 / 1 / 8
/
65. / Capitationis a good wayofstoppingNHIS members from movingfromone providerto anotherwithoutany good reason. / 4 / 3 / 2 / 1 / 8
/
Continuity of care
66. / Capitationis good becauseIhave onlyone providerwho knows myhealth problems for betterdiagnosis and treatment. / 4 / 3 / 2 / 1 / 8
/
67. / Capitationis good becauseif myPPP cannot take care of mydisease, s/he willrefer me to anotherplace for care. / 4 / 3 / 2 / 1 / 8
/
68. / Capitationis good because,nowyou know who your primarycare provideris, and(s)he also knows you sotreatmentbecomes very easyand effective. / 4 / 3 / 2 / 1 / 8
/
Now,Iwould like you toshare with me your finalimpressions aboutcapitation and the NHIS
69. / Howwillyou ratethe trustthatyourprimary careprovider willgive youthe bestof treatmentthatyou expect? / 1.VERYHIGH
2.HIGH
3.LOW
4.VERYLOW /
70. / Do you intend changing your PPP afterthe 6 months period? / 1.YES
2.NO(If “NO” go to70) /
71. / Why would you wantto change your PPP? / 1.POORSERVICEQUALITY
2.NOSKILLEDSTAFFAVAILABLE
3.NOGOODMEDICINES
4.OTHER: /
72. / Considering your experience withcapitation, would you renew your cardwhen itexpires? / 1.YES
2.NO /
73. / Considering your experience withcapitation, would you recommend anyone without insurance cardto registerwiththe NHIS? / 1.YES
2.NO /
74. / On the basis ofyour experienceso far, how would you ratethe Capitation? / 1.VERYGOOD
2.GOOD
3.BAD
4.VERYBAD /
75. / On the basis ofyour experience withthe
NHIS so far, howwould you rateScheme? / 1.VERYGOOD
2.GOOD
3.BAD
4.VERYBAD /

Thankyouverymuchforyourcooperation.Ifthereareanyquestionsthatyou wanttoaskme,oranyissuesthatyouwantmetoexplainorclarifytoyou,Ishallbeveryhappytodoso.

Subscriber questionnaires