Abstract
PurposeThis paper aims to examine the factors that affect the quality of healthcare services in the implementation of the National Health Insurance Scheme (NHIS) at the local level in Ghana from the perspectives of health policy implementers and beneficiaries in public-private organisations.Design/methodology/approachThis paper has adopted a mixed research method with both qualitative and quantitative data, with in-depth interviews, document analysis and focus groups discussions. A total of 107 participants took part in the interviews and the questionnaire survey.FindingsThe study found that these factors greatly affect the quality of healthcare services from the implementers’ perspectives — referrals, effectiveness in monitoring, timeliness, efficiency, reimbursement, compliance with standard guidelines of Ghana Health Service (GHS) and accreditation process. For the beneficiaries, three healthcare services factors are important, including medical consultations, diagnostic services and the supply of drugs and medicines. Some other factors are found to be the least prioritized healthcare services, namely the issuance of prescription forms, verification of identification (ID) cards and staff attitude. However, the study found that implementers and beneficiaries exhibited a mixed reaction (perspectives) on accessing some healthcare services. In some healthcare services where the implementers perceived that beneficiaries have more access to such services, the beneficiaries think otherwise, an irony in the perspectives of the two actors.Originality/valueThis paper adds to the extant literature on the perspectives of policy implementers and beneficiaries on factors that affect the quality of healthcare services in general and specifically on the implementation of NHIS in Ghana with the public-private dimension.
Highlights
This paper examines the factors that affect the quality of healthcare services in the context of the implementation of the National Health Insurance Scheme (NHIS) in Ghana
Other factors mentioned by the implementers include administration of the tariff system, the state of medical equipment in health facilities including laboratories, the caseload of health workers, doing the right thing, the right time, waiting times, the work environment, efficacious services and meeting the health needs and the satisfaction of subscribers
The healthcare service that most implementers perceived that the beneficiaries have more access to is on medical consultations (88.5 percent) while the least perceived healthcare service is on medical emergencies (46.1 percent)
Summary
This paper examines the factors that affect the quality of healthcare services in the context of the implementation of the National Health Insurance Scheme (NHIS) in Ghana. The NHIS is initiated by the Government of Ghana in 2003 and implemented in 2004 It is backed by the National Health Insurance Laws and a Legislative Instrument (LI) I.1809 (Government of Ghana, 2003, 2004, 2012). The purpose of the NHIS is to “secure the provision of basic healthcare services to persons resident in the country through mutual and private health insurance schemes; to put in place a body to register, license and regulate health insurance. The full terms of this license may be seen at http://creativecommons.org/licences/by/4.0/ legalcode
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