Abstract
Principal-agent relationship exists between health service providers and their authority and clients. It asserts that health service providers as ‘imperfect agents’ of the authority and clients will take actions that aim to maximise profits at the expense of authority and clients (principal). The situation is possible when reimbursement is based on fee-for-service or a diagnosis-related groups. It looks at relationships between health service providers as agents and health insurance authority, and clients as principals in areas of provision of health services, supply of drugs, medicines and reimbursement. Results showed the private health service providers prescribed more drugs and medicines for clients towards profit maximisation (agency) than their public counterparts. Also, it was found that the public health service providers continued to provide health services and drugs despite health insurance authority indebtedness to them exhibiting more stewardship towards health insurance authority. It recommends strict regulations in tariffs/vetting claims and prompt reimbursement.
Highlights
This article focuses on three actors namely National Health Insurance Authority, health service providers and health insurance clients
The aim of this study is to examines the implementation of National Health Insurance Scheme (NHIS) in the context of principal-agent relationships in the provision of health services, supply of drugs and medicines and the processes of reimbursement for the services and drugs supplied to health insurance clients in a developing world context of Ghana
The study adds to existing literature on ‘agency shirking’, it adds to knowledge in a new direction that, it is the agents that ‘shirk responsibilities’ but principals were found to be engaged in what the authors termed ‘shift of responsibility’ in the implementation of NHIS in Ghana
Summary
This article focuses on three actors namely National Health Insurance Authority, health service providers and health insurance clients. NHIA is responsible for the implementation of National Health Insurance Scheme (NHIS) in Ghana In this principal-agent relationship, NHIA (principal) contracts health service providers (agents) to provider healthcare services, drugs and medicines to health insurance clients. The aim of this study is to examines the implementation of National Health Insurance Scheme (NHIS) in the context of principal-agent relationships in the provision of health services, supply of drugs and medicines and the processes of reimbursement for the services and drugs supplied to health insurance clients in a developing world context of Ghana. The study attempts to bridge the seemingly gap between public and private sector management and supply of drugs and medicines in retail and bulk distribution as well as managerial interests couple with principal interests It examines issues of interests’ divergence in both sectors
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