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TL;DR
The study found that gender, professional cadre, facility level, and region influenced preferences, with capitation being the least preferred option across all service areas.
BMC Health Services Research · 5 authors, 4 centres
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The study found that gender, professional cadre, facility level, and region influenced preferences, with capitation being the least preferred option across all service areas.
This was a nationally representative, facility-based cross-sectional study using probability proportionate to size sampling to select healthcare workers (HCWs) from public health facilities in The Gambia. HCWs were presented with options for provider payment systems (PPS) across major service areas. Descriptive statistics and multinomial logistic regressions analyzed associations between HCW/facility characteristics and PPS preferences. The majority of HCWs lacked insurance coverage but were willing to join the NHIS. Key findings included that gender, professional cadre, facility level, and region significantly influenced preferences, with capitation being the least preferred PPS across all areas. Specific associations included a negative association between female HCWs and per-diem for hospitalization, and a positive association between female HCWs and fee-for-service for referral services. Limitations included exclusion of private facilities and low response from hospital administrators, which may limit comprehensiveness. The study suggests the NHIA should consider HCW preferences and contextual factors when selecting a mix of payment systems to align incentives and support universal health coverage goals.