Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach

Table 5

Themes and representative quotations related to how the direct-pay system and e-claim system initiative might influence overall performance of EMS systems.

Themes	Representative quotations
Governance	“Previously, we were burdened by auditing and data-entry functions of claim papers pooled from all EMS units. Under the direct-pay system, we no longer do the data entry and the money transfer to EMS units.” (staff of provincial health office in a province with participating EMS units)
Service delivery	“It is very difficult to cover remote rural areas with EMS services due to poor road conditions and low population density.”(staff of provincial health office in a province with or without participating EMS units)
Human resources	“We worried about EMS practitioners working for local authorities or charitable organizations have been under compensated given the amount of minimum wage declared by the government…. turnover rate of these folks is usually high.”(administrative staff of a local authority)
Financing	“These days (under direct-pay system), we do not need to wait for EDC to fill ITEMS data form for each patient in order to fill in our part on the same data form.” (EMS practitioner)
Information	“We can trace whether the number of claims we made was accordingly submitted to NIEMS for reimbursement…this was not possible in the past.” (hospital administrator)
	“E-claim system automatically filled in the data related to the license plate number of a car involved in a crash accident such as an insurance policy number.” (hospital administrator)
Technology	“RVP provided an application on mobile phone to facilitate transferring of on-scene capturing of license plate numbers or chassis numbers of motor vehicles involved in a crash event.”(EMS practitioner)