First year improvements in Uganda OBA clinic utilization and claims quality
This piece is cross-posted from the Uganda output-based aid (OBA) site which just got a major under-the-hood overhaul in its move to a blog format. The Uganda OBA project contracts private clinics to see qualified patients for complaints of suspected sexually transmitted infections (STIs). Patients who buy a subsidized voucher from local drug shops and pharmacies are entitled to seek care for themselves and their partner at any of the contracted clinics. Clinics are reimbursed on a negotiated fee-for-service schedule.
The following report (“VSHD, 2007, Assessment of OBA Clinic Utilization”) is an evaluation of the OBA program’s first year impact on utilization at participating clinics (July 2006 to June 2007). The study, led by Berkeley graduate students Richard Lowe and Ben Bellows, was undertaken June to August 2007 and required an extensive review of thousands of handwritten lab and outpatient entries at OBA facilities. Records were kept differently at many of the clinics and,at several clinics, data were simply not available. However, we have information from 7 of the 16 clinics and they indicate a strong patient uptake and program improvement in the first year of OBA. One of the more dramatic findings is that the total number of patient visits at contracted clinics increased 226% in the first year of OBA compared to the year before OBA.
It does not appear that patients who have attended OBA clinics simply substituted the OBA voucher for their own out-of-pocket spending. Taking all seven clinics together, the number of non-OBA patients seeking STI treatment actually increased in the first year of OBA. One likely reason is that social marketing stimulated greater demand for STI treatment beyond the voucher-using population.
Program adherence also appears to be improving over the first year of OBA as the number of fully paid claims increased from 30% of all submitted claims in July/August 2006 to 70% of all claims in June 2007. Although it should be stressed that claims quality varied significantly between providers.
There is some concern about the quality of lab testing at participating clinics. Lab technicians could benefit from better on-site follow-up and incentives for high quality diagnoses. However, the percent of positive gonorrhea tests more than doubled, indicating increased awareness of this infection in the community and at provider clinics.
The report paints a detailed picture of the participating clinics in their first year of OBA and it is hoped that findings can be used for program improvement as the expansion is planned.
Our many thanks go to both Microcare and MSI who graciously assisted with our many requests for supplemental data and assistance reaching clinic providers. Many thanks as well to the KfW Development Bank and the Bixby Program at UC Berkeley for funding the research.