National health insurance in Ghana : evaluation of the Nzema-East Natural Health Insurance Scheme
Document type: mthesis
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Abstract:
Health Insurance is one of the main mechanisms of health care financing prominent on the global policy agenda. In 2004, Ghana implemented a health financing reform to replace user-fees with a National Health Insurance Scheme (NHIS). Prior to its implementation, access to healthcare was solely based on ability to pay, emanating from a policy in 1985 which introduced user-fees, popularly called “cash and carry” system. This caused a marked decline in health services utilization whilst apparently the NHIS, has increased outpatient department (OPD) utilization, with marked national enrolment. However, this is happening amidst poor operational capacity and scheme’s governance. It was with this background, that this study sought to evaluate the performance of the Nzema-East District Mutual Health Insurance Scheme (NEDMHIS), employing it as a descriptive case study using the Robert Stakes Model emphasizing the anticipated conditions and means for the NHIS implementation, and what pertains in the Nzema-East district (NED) for the NEDMHIS, with respect to the health financing sub-functions. Findings of this study show that, the NEDMHIS enrolment seems commendable with just 2 years of implementation, and that its annual administrative costs were always within the 20% limit permitted by law. Aside the increased OPD utilization, with its attendant challenges of increased health staff workload, tending to compromise quality, it appeared that insured clients sought care earlier and hence presented with “less severe disease”, as evidenced by less admissions and mortality; and that the non-insured tended to postpone seeking of health care. In addition, Axim hospital’s revenue generation apparently has increased markedly with NEDMHIS implementation. However, the scheme is plagued with challenges relating to technical capacity, infrastructure and scheme’s governance, and that the large informal sector in NED, which is difficult to reach, has made premium collection very challenging. This study, therefore, recommends that a minimum administrative capacity and infrastructure should be in place before embarking on health insurance, and this needs to be addressed by the NEDMHIS. Furthermore, the indigents criteria need amendment as it undermines financial accessibility of perhaps the most vulnerable. Moreover, the NHIS needs to be really “mandatory” in order to increase risk pooling and financial sustainability of the Schemes.
Authors:
Boakye, K.B.
Country:
Ghana
Category:
Research
Department:
Development Policy & Practice
Institute:
KIT (Royal Tropical Institute)
Keywords:
health services
Language:
eng
Organization:
KIT - Royal Tropical Institute
PAGE:
v, 57
Year:
2008
Region:
West Africa
Right:
© 2008 Boakye
Subject:
Health and Nutrition
Title:
National health insurance in Ghana : evaluation of the Nzema-East Natural Health Insurance Scheme
Training:
Master of Public Health / International Course in Health Development (ICHD)