Abstract
BackgroundGhana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices under the NHIS as perceived by public and private service providers.MethodsThis study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana between July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of public and private sector providers (government and mission hospitals, private hospitals and private standalone pharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview guides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of medicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and also in response to themes that emerged from the transcripts and notes.ResultsMost KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by removing cost barriers for patients; however, some pointed out the increased utilization could also be corollary to moral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low reimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs reported important differences between private and public sectors including weak separation of prescribing and dispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects of unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers (especially pharmacies and licensed chemical sellers) in the NHIS.ConclusionsHealth providers generally perceive the NHIS to have had a largely positive impact on access to medicines. However, concerns remain about equity in access to medicines and the differences in quality of pharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the implementation of health insurance schemes is important to identify and address the potential consequences of medicines policies and practices under the scheme.Electronic supplementary materialThe online version of this article (doi:10.1186/s40545-016-0055-9) contains supplementary material, which is available to authorized users.
Highlights
Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services
The NHIS is primarily financed by funds generated from a National Health Insurance Levy (a 2.5 % levy on goods and services collected under the Value Added Tax (VAT) system), 2.5 percentage points of formal sector employees’ monthly social security contributions, and premiums paid by subscribers in the informal sector [5, 6]
The results are presented according to the key areas of medicines management: 1) Accreditation process and discontinuation of service provision under the NHIS; 2) Reimbursement practices for public and private sector service provision; 3) Selecting medicines for purchase and use by facilities; 4) Purchasing and pricing of medicines; and 5) Improving medicines utilization
Summary
Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. Ghana established the NHIS through a National Health Insurance Law (Act 650) in 2003 to ensure more equitable financing of health care and to improve access to health services in the country [4]. Formal sector employees and the self-employed who make social security contributions, children under the age of 18, individuals 70 years old and above, pregnant women, indigents, categories of differently-abled persons, persons with mental disorder, and social security pensioners do not pay membership premiums [7] These groups constitute 69 % of active NHIS members. The benefit package of the NHIS covers 95 % of disease conditions in the country [5, 7]
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