A review of the literature on the current state of health care payment models in the economic community of west African states (ECOWAS)

Objective: To assess the current health care payment models in West Africa as a measure of the feasibility for the expansion of chiropractic practice in the region. Design: A systematic literature review Methods: We conducted electronic searches from 1995 – 2012 using PubMed and African Journals Online (AJOL) to identify studies on health care utility and payment structures in West Africa. Results: There are broad socioeconomic disparities in all of the assessed countries and access to the best health services are reserved for the wealthy. Several countries have adopted health care compensation models that enable low and middle income residents to gain access to health care at no or minimal cost; however none of these models includes chiropractic care. Utility and outcomes are varied and dependent on such factors as co-payments, fees, availability of health care providers, material resources and community education. Cultural factors such as willingness to pay and bidding for services have some influence. Some countries are adopting national health insurance policies, while others have elected to advance health maintenance organizations and private insurance. Chiropractors and chiropractic institutions seeking to expand to West Africa should anticipate working in an environment in which patients with limited means will be expected to pay out of pocket or use some type of barter arrangement to cover the costs of chiropractic services.