Abstract
Background: the main aim of the study is to find if the National Health Insurance Scheme (NHIS) in Ghana is achieving universal health coverage (UHC) or not. The study gives the trajectories of health policies in Ghana and their implications on long term health financing. NHIS in Ghana was implemented in 2004, with the aim of increasing subscribers’ access to health care services and reduce financial barriers to health care. On equity access to healthcare, it addresses two core concerns: (1) enrolling particular groups (persons exempted from annual premium payments) and (2) achieving UHC for all citizens and persons with legal residence. It utilizes a multifactor approach to the conceptualization of UHC. The research question: Is Ghana’s NHIS on course to deliver or achieve universal health coverage? Methods: we used qualitative methods. In doing so, the study engaged participants in in-depth interviews, focus group discussions and direct observations of participants in their natural settings, like hospitals, clinics, offices and homes, with purposive and snowball techniques. This data triangulation approach aims to increase the reliability and validity of findings. Results: the empirical evidence shows NHIS performed relatively well in enrolling more exempt groups (particular groups) than enrolling all persons in Ghana (UHC). The biggest challenge for the implementation of NHIS from the perspectives of health insurance officials is inadequate funding. The health insurance beneficiaries complained of delays during registrations and renewals. They also complained of poor attitude of some health insurance officials and health workers at facilities. Conclusions: both health insurance officials and beneficiaries emphasized the need for increased public education and for implementers to adopt a friendly attitude towards clients. To move towards achieving UHC, there is a need to redesign the policy, to move it from current voluntary contributions, to adopt a broad tax-based approach to cover all citizens and persons with legal residence in Ghana. Also, to adopt a flexible premium payment system (specifically ‘payments by installation’ or ‘part payments’) and widen the scope of exempt groups as a way of enrolling more into the NHIS.
Highlights
Ghana gained her political independence in 1957 and has since assumed her own public policies, including health policies
These strategies were possible due to the prolonged stay in the field. These explained the rationale for the three phases of data collection [21,22]. We addressed these ethical issues by seeking for institutional permissions from the Ghana Health Service (GHS) and the NHIA
The results focused on National Health Insurance Scheme (NHIS) coverage for all persons in Ghana, including citizens and other persons resident in Ghana
Summary
Ghana gained her political independence in 1957 and has since assumed her own public policies, including health policies. Ghana’s health policy at independence was ‘free health care for all’. The implementation process of ‘free health care for all’ was limited to public health facilities (hospitals, clinics) with less involvement of private health facilities, especially private for-profit facilities [1,2].
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