A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

Robert Kaba Alhassan,Daniel Kojo Arhinful,Edward Nketiah-Amponsah,Jonathan A Coles

doi:10.1371/journal.pone.0165151

Abstract

BackgroundThe introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana.MethodsElectronic search was done for literature published between 2003–2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context.ResultsAbility of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients’ trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper.ConclusionsThe NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.

Highlights

Universal access to good quality health care remains a major concern of health systems globally
Ability of the national health insurance scheme (NHIS) to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement
The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme

Summary

Introduction

Universal access to good quality health care remains a major concern of health systems globally. The operational and financial sustainability of these health insurance interventions has been a major challenge to many of these low and middle income countries in Africa, including Ghana. Kyomugisha et al [4] reported that the Ugandan Community Health Insurance (CHI) system was not sustainable largely because it was operated on a small budget; had low enrolment and lacked government support. De Allegri et al [5] concluded that lack of clear legislation, low enrolment, insufficient risk management, weak managerial capacity and high overhead costs, are key operational challenges that threaten the sustainability of CHI in South Africa. Stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme.

Methods

Results

Discussion

Conclusion