The impact of capitation on health insurance membership and the provision of care in Ghana

Abstract To address escalating health care costs, in 2012, Ghana piloted a capitation model in Ashanti. Employing a difference‐in‐differences method, we use data from 2010 to 2014 to examine the impact of capitation on insurance membership and the provision of care. Relative to control districts, capitation reduced membership by 39%, along with total outpatient usage (48%) and cost (38%). However, per‐member usage did not change, and per‐member cost increased. Additionally, given rising inpatient cost (an avenue not affected by capitation), there is some evidence of a cost‐shift. Capitation also had an inequitable impact, particularly reducing membership among the poor.