Abstract
Recent studies on health financing reform in Ghana have focused on the institutional legacies and political forces underpinning the dramatic shift from “cash-and-carry” to policy initiatives that find expression in universalism and social inclusion. Yet little attention has been paid to the complex interactions between institutional and ideational elements that account for the policy failure of Ghana’s National Health Insurance Scheme (NHIS). Drawing primarily on government records, published books, articles and newspaper publications, we argue that formulating appropriate financial reform strategies requires a proper understanding of how national identities intersect with, and shape the politics, design, and operation of social programs to inform policy outcomes. The article suggests that the sustainability of Ghana’s NHIS rests on strategic reform measures including, cost containment, diversified funding and operational arrangement, as well as depoliticization of the health regime. Keywords :Health insurance, health politics, social protection, social citizenship, cost recovery, health financing DOI: 10.7176/PPAR/11-1-05 Publication date: January 31 st 2021
Highlights
Good health is one of the most important dimensions of human life, and a very essential determinant of a person’s capabilities (Sen 1999, 2002)
Beyond its intrinsic value, health is instrumental in shaping the educational fortunes, employability, cognitive development, income earning abilities, and social status enhancing elements relating to participation in governance, dignity, safety, security and empowerment of the citizenry
Health care is a critical component of social citizenship and a political symbol that rests on distribution, provision, and access (Béland, Foli, & Kpessa-Whyte, 2018; Johnson Redden, 2002)
Summary
Good health is one of the most important dimensions of human life, and a very essential determinant of a person’s capabilities (Sen 1999, 2002). The second layer of the national health insurance system in Ghana is the community mutual health insurance schemes, which are essentially resource-pooling arrangements for people living in a common locality with the purpose of financing the cost of healthcare for their members These types of strategic adaptation schemes originated as forms of local citizen’s resistance that emerged against the cash-and carry regime when communities began to make contributions into common pool to collectively mitigate the risks associated with the commodification of health services. In a sense, they were illustrations of how the power of the people disempowered the force of public policy by pointing to alternative financing arrangements that influenced the shift to national health insurance in Ghana. While Ashanti Region has the highest number of the exempted members, Upper West Region has the lowest proportion of exempted NHIS members
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