Feasibility of a National Health Insurance Scheme in the Gambia: Health Care Providers and Consumers Perspectives on the Design

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Title: Feasibility of a National Health Insurance Scheme in the Gambia: Health Care Providers and Consumers Perspectives on the Design Author: Hassan Njie Thesis advisor: Professor Herng Ching Lin Background: Developing countries have been and still are grappling with high catastrophic financial payments, which have created financial barriers to health service utilization. Studies have also shown that developing countries including low and middle- income countries (LMICs) are considering reforms in their health care systems to provide universal health coverage (Mills et al. 2012). The aim of this study is to explore the feasibility of a national health insurance scheme in the Gambia by sounding the perspectives of health care providers and consumers Methods and Materials: The study adopted a descriptive cross sectional survey using a questionnaire that has four dimensions. Study participants comprised health care providers (125) and consumers (125) totaling 250 participants. Data was collected in all the six public hospitals in the Gambia from 1st August to 20th August. IBM SPSS (Version 22) was used to analyze data. Data analysis were exclusively descriptive statistics Results: Overwhelming majorities of study population are strongly in favor of a national health insurance scheme in the Gambia (97.2%) and 88% think it is feasible. Half of the study population thinks tax should be the main source of funding for the health insurance scheme in the Gambia (48.4%) with out-of- pocket payment less preferred (6.0%). Majority of the study population preferred Capitation (40%) as payment method for health care providers. Fee For Performance was ranked second (30.8%) while Per Diem was least preferred (9.2%). About two- third of participants prefer a gatekeeper in the national health insurance scheme (75.2%) while 14.4% disagreed with the remaining 10.4% undecided. 83.2% of study participants thinks health care providers should be accredited before they are reimbursed by the national health insurance scheme Conclusion: the government of the Gambia must ensure that all stakeholders are consulted during the planning, design and implementation of national health insurance scheme. This will enhance inclusiveness, acceptance and provide support to the scheme. The government should also look into external sources of funding for the health insurance scheme such as donor agencies and bilateral partners who fund the largest share of total health spending in the country. Discussions should center on providing subsidy for the poor, women and children who are the most vulnerable in society. More research specifically large-scale longitudinal studies surveying key stakeholders is recommended.