Health Insurance In Ghana Research Articles

Internal Migration and Access to Health Insurance in Ghana: A Gendered Perspective

Internal Migration and Access to Health Insurance in Ghana: A Gendered Perspective

Global economic meltdown and healthcare financing in Ghana.

Global economic meltdown and healthcare financing in Ghana.

Policy transfer and health policymaking process: The case of social health insurance in Ghana

Since the introduction of the user fee system of healthcare financing in 1969 and its subsequent modifications, the burden of healthcare expenditure on residents of Ghana created health inequality. This system encouraged the poor and vulnerable to have limited access to essential drugs and services. Policy entrepreneurs contributed to raising awareness about the poor and vulnerable people in Ghana not having access to health due to the user fee system as a public policy problem. This awareness began to spread among political leaders, the masses, and professional groups, warranting the attention of policymakers. As significant public dissatisfaction and agitation against the user fee policy continued, the media continued to hold the government responsible for initiating the policy. The democratization process and election period between 1998 and 2000 provided a window of opportunity that led to the idea of health policy change. In 2003, Ghana established the National Social Health Insurance, a form of Social Health Insurance. This study examines the process of establishing the social health insurance scheme through policy transfer framework. First, the paper examines Ghana’s health policy after independence, the National Health Service, and the User Fee Policy that was implemented in 1985. Second, the paper accessed the policy transfer framework and applied it to the transfer of social health insurance. Third, the paper explains the radical change from the user fee policy to the social health insurance model. This essay uses time series analysis and comparative analysis to assess the impact of the social health insurance on the under-five mortality ratio, maternal mortality ratio and out-of-pocket expenditure. The assessment results show that the social health insurance scheme has a positive impact on under-five mortality, maternal mortality and out-of-pocket payment compared to Nigeria without social health insurance for the poor and other vulnerable groups. The paper concludes that policy transfer alone cannot be a single variable to explain radical health policy change, but when combined with other complementary perspectives, an empirically grounded account of policy change can be developed.

Socioeconomic and demographic correlates of nonenrolment onto the national health insurance scheme among children in Ghana: Insight from the 2017/18 Multiple Indicator Cluster Survey.

The goal of Ghana's health insurance scheme is to achieve universal coverage. Despite NHIS' benefits to children, not all children in Ghana are covered. This study investigates the sociodemographic covariates of nonenrolment onto the national health insurance scheme among children in Ghana. We used the child dataset of the 2017/18 Ghana Multiple Indicator Cluster Survey (G-MICS). We used STATA version 14 for the data analyses. We described each study variable using frequency and percentages. We used Poisson regression to estimate crude and adjusted prevalence ratios of the relationship between the covariates and the outcome variable. Approximately 57% of children were covered with health insurance in Ghana. In the adjusted multivariable model, male children, children within the ages of 10-14 or 15-17years, and children who have some form of functional disability and those with no information on their functional disability status, children of mothers with lower than post-secondary education, and children residing in households of less than the fifth quantile on the household wealth index were associated with a higher likelihood of nonenrolment onto the national health insurance scheme. Finally, compared to the children in greater Accra, children in the other nine regions were associated with a lower likelihood of nonenrolment onto the national health insurance scheme. Given the results, improvement in health insurance coverage should be done, taking into consideration variations across the socio-demographic characteristics of the child, mother, and households.

The Social Value of Health Insurance: Results from Ghana

We use the roll-out of the national health insurance in Ghana to assess the cushioning effect of coverage on the financial consequences of health shocks and resulting changes in coping behaviors. We find a strong reduction in medical expenditures, preventing households from cutting non-food consumption and causing a decrease in the volume of received remittances as well as labor supply of healthy adult household members. Moreover, we present evidence that the insurance scheme reduced the likelihood that households experiencing a health shock pulled their children out of school in order to put them to work. Avoidance of such costly coping mechanisms is potentially an important part of the social value of formal health insurance.

Self-undermining policy feedback and the creation of National Health Insurance in Ghana.

Contributing to the ongoing debate about policy feedback in comparative public policy research, this article examines the evolution of healthcare financing policy in Ghana. More specifically, this article investigates the shift in healthcare financing from full cost recovery, known as 'cash-and-carry', to a nation-wide public health insurance policy called the National Health Insurance Scheme (NHIS). It argues that unintended, self-undermining feedback effects from the existing health policy constrained the menu of options available to reformers, while simultaneously opening a window of opportunity for transformative policy change. The study advances the current public policy scholarship by showing how the interaction between policy feedbacks and other factors-particularly ideas and electoral pressures-can bring about path-departing policy change. Given the dearth of scholarship on self-undermining policy feedback effects in the Global South, this contribution's originality lies in its application of the novel theory to the sub-Saharan African context.

The politics of state welfare expansion in Africa: Emergence of national health insurance in Ghana, 1993-2004

The politics of state welfare expansion in Africa: Emergence of national health insurance in Ghana, 1993-2004

The Politics of State Welfare Expansion in Africa: Emergence of National Health Insurance in Ghana, 1993-2004

After years of military rule, Ghana returned to democratic governance in January 1993. Since then, it has consolidated its democracy, evidenced by seven successive general elections, three alternations of power, and institutional actors using the rules of the game to pressure elected officials to influence policy development and implementation. This article examines the passage of massive state expansion of welfare legislation in 2003, the National Health Insurance Law (Act 650). I argue that not only was healthcare reform a salient issue in the 2000 general elections, the new law was the result of civil society and citizen pressure on the governing New Patriotic Party to fulfill its campaign promise to overhaul the country's healthcare system. This article contributes to the literature on the welfare state from the developing world, which mostly focuses on Latin America and Asia.

Perceived satisfaction with health services under National Health Insurance Scheme: Clients' perspectives

The study aims to explore the perceived satisfaction of insured clients in financing health services through National Health Insurance in Ghana. A quantitative method was used to recruit 380 respondents, selected by multistage cluster sampling. Data were collected through the administration of questionnaires. More than half, 57.9%, of respondents were males, and the average age was 34years. Most respondents, 74.3%, were insured. Overall, 53.12% of insured clients were dissatisfied with the services of providers. Factors, such as benefit package of insurance, willingness to pay higher premium, and perceived discrimination were significantly associated with poor satisfaction with health services. The current advocacy for and awareness about the use of health insurance as a prepayment plan should be prioritised in policy initiatives. The benefit package for the insurance should be increased in order to cover all disease conditions that afflict the Ghanaian population.

Perceptions of healthcare quality in Ghana: Does health insurance status matter?

This study’s objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare for both the insured and uninsured.

Sustaining Ghana’s National Health Insurance Scheme Through Preventive Healthcare Strategies and Legislation

This article focuses primarily on secondary literature to highlight some of the key issues that has affected the effectiveness and the efficiency of the National Health Insurance in Ghana. The article proposes the need to use legislation and additional preventive healthcare strategies to lessen or reduce the pressure that comes upon the National Health Insurance Authority. Finally, it postulates that the people of a community, their institution, that is health institutions and Para-health institutions that ensure public safety, environmental protection, and sanitation among others are enjoined to reduce the occurrence of disease and injury or harm. This could ensure a healthy work force and a healthy population that has the tendency or proclivity to increase productivity and lessen disease burden with its associated harm and cost on the state, especially in countries where social insurance is practiced.

Transnational actors and health care reform: Why international organizations initially opposed, and later supported, social health insurance in Ghana

Much has been written about the impact of transnational actors on health and social policy. In this article, we show how some international organizations’ efforts to prevent Ghana from enacting a social health insurance program in 2003 failed. We then explain why the Ghanaian government ignored these organizations’ advice and even excluded them from the policy formulation process altogether. Finally, we explore these organizations’ logic as they came to accept and even promote the new Ghanaian policy internationally. As argued, a temporal perspective on the impact of transnational actors and the way their prescriptions change over time is necessary if one is to capture transnational policy influence and its limitations. A temporal perspective is also important in explaining the logic of accommodation on the part of these actors, since this only becomes apparent over time. This is precisely why our qualitative analysis traces both domestic policy development and the changing nature of transnational ideas and prescriptions.

A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

BackgroundThe introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana.MethodsElectronic search was done for literature published between 2003–2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context.ResultsAbility of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients’ trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper.ConclusionsThe NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.

The Impact of Social Health Insurance on Household Fertility Decisions

While fertility rates generally fall over time as an economy develops, there is also evidence, primarily from developed countries, of pro-cyclical fertility. Fertility rates are correlated with short-run economic fluctuations because women delay pregnancy in poor economic times and periods of uncertainty, and increase fertility when conditions improve. Because health insurance reduces the cost of childbirth and medical care for children, the introduction of social health insurance may have the same effect on fertility as a positive income shock. This paper examines whether the introduction of social health insurance in Ghana had a positive, pro-cyclical effect on fertility decisions. Using data from the 2005/2006 Ghana Living Standards Surveys (GLSS) conducted shortly after the roll out of the insurance programme and the 2012/2013 GLSS, we compare fertility decisions of insured and uninsured women. To control for self-selection into the insurance programme, we exploit district-level variation in the dates of implementation of the national health insurance to instrument for insurance enrolment. We find evidence of a pro-cyclical fertility effect at the individual level. This is consistent with an increase in national fertility rates observed around the time the programme was introduced. The increase in fertility, however, appears to have been temporary; we find no effect of insurance on fertility in the more recent data.

Health insurance and quality of care: Comparing perceptions of quality between insured and uninsured patients in Ghana's hospitals.

BackgroundThe introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected hospitals in Ghana to determine whether there is any unequal treatment between insured and uninsured patients in terms of quality of care, as empirical and anecdotal evidence seem to suggest.MethodsA cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics, including frequency distributions, means and standard deviations, were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the association between health insurance and quality of care.ResultsOverall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with.ConclusionsIt was concluded that generally, insured and uninsured patients are not treated unequally, contrary to prevailing anecdotal and empirical evidence. On the contrary, quality of care is a concern of both insured and uninsured patients.

Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care.

BackgroundThere is considerable interest in exploring the potential of social health insurance in Africa where a number of countries are currently experimenting with different approaches. Since these schemes have been introduced recently and are continuously evolving, it is important to evaluate their effectiveness in the enhancement of health care utilization and reduction of out-of-pocket expenses for potential policy suggestions.ObjectiveTo investigate how the National Health Insurance Schemes (NHIS) in Ghana affects the utilization of maternal health care services and medical out-of-pocket expenses.MethodsWe used nationally-representative household data from the Ghana Demographic and Health Survey (GDHS). We analyzed the 2014 GDHS focusing on four outcome variables, i.e. antenatal check up, delivery in a health facility, delivery assisted by a trained person and out-of-pocket expenditure. We estimated probit and bivariate probit models to take into account the issue of self selection into the health insurance schemes.ResultsThe results suggest that, also taking into account the issue of self selection into the health insurance schemes, the NHIS enrollment positively affects the probability of formal antenatal check-ups before delivery, the probability of delivery in an institution and the probability of being assisted during delivery by a trained person. On the contrary, we find that, once the issue of self-selection is taken into account, the NHIS enrollment does not have a significant effect on out-of-pocket expenditure at the extensive margin.ConclusionSince a greater utilization of health-care services has a strong positive effect on the current and future health status of women and their children, the health-care authorities in Ghana should make every effort to extend this coverage. In particular, since the results of the first step of the bivariate probit regressions suggest that the educational attainment of women is a strong determinant of enrollment, and those with low education and unable to read are less likely to enroll, information on the NHIS should be disseminated in ways that reach those with little or no education. Moreover, the availability of government health facilities in a region is associated with higher likelihood of enrollment in the NHIS. Accordingly, extending geographical access is an important strategy for expanding NHIS membership and improving access to health-care.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-016-0083-9) contains supplementary material, which is available to authorized users.

PHS116 - Eight Years Of National Health Insurance In Ghana: Evaluation Of The Health Financing Sub-Functions

PHS116 - Eight Years Of National Health Insurance In Ghana: Evaluation Of The Health Financing Sub-Functions

Demand for Health Insurance in Ghana: What Factors Influence Enrollment?

In 2003, there was a paradigm shift in Ghana's quest for a more humane, affordable and reliable mechanism of financing healthcare with the introduction of the national health insurance scheme. The scheme was to replace the hitherto obnoxious Cash and Carry System of paying for health care at the point of service, and to provide a better and much more humane financial arrangement that will enable the citizens to access health care service without having to pay at the point of service delivery and also ensure an improvement in the quality of basic health. This study employed descriptive statistics-Logit and Probit Models to investigate the factors that influence Ghanaians to enroll with the scheme. The results from the logit and probit models indicate that sex, marital status and cost of curative care were strong factors in influencing one's decision to join the scheme. Again the marginal effects and odd ratios gave a further indication that factors such as individuals' income, higher levels of education and poor ill health among others also influence Ghanaians to join the scheme. This research is of the view that any public education aimed at increasing enrollment should be guided by these factors.

The legal framework of social security systems in developing countries – the example of national health insurance in Ghana

"Law and Politics in Africa, Asia and Latin America" analyses legal and constitutional developments in all states or regions outside of Europe as well as their regional and international integration. Founded in 1968 and inspired by decolonization and the idea of a cooperative new beginning, the Journal also promotes a special interest in contributions on 'Law and development'. The journal aims to provide a forum for a variety of perspectives on these fields of interest, be they focused on one country or comparative, theoretical or methodological in nature. Next to extensive articles, the journal publishes shorter reports about current events or conferences as well as book reviews. As a special service, each issue of "Law and Politics in Africa, Asia and Latin America" contains an international bibliography of relevant publications from around the world. This is compiled in cooperation with the Leibniz-Institute for Global and Regional Studies in Hamburg (GIGA). "Law and Politics" addresses authors and readers on all continents and aims to serve as a forum of mutual exchange. The journal is open for contributions from legal and social sciences as well as for analyses from practitioners. The journal is published quarterly and welcomes contributions in German, English, Spanish and French. Website: www.vrue.nomos.de

Knowledge, perceptions and expectations of capitation payment system in a health insurance setting: a repeated survey of clients and health providers in Kumasi, Ghana.

BackgroundHealth insurance is improving access to quality health care in Ghana. However, there are implementation challenges which call for reform of the current health insurance system. There is no doubt that reforming the current health insurance in Ghana is besieged with a myriad of problems due to misconceptions and misinformation. This study explored the perceptions and understanding of clients and health providers on the capitation payment system in the Kumasi metropolis.MethodsThe study employed a cross - sectional design and repeated surveys were conducted with a cohort of 422 NHIS policy holders aged 18–69 years in each survey. The surveys were conducted in every three months. Health service providers and clients from thirteen (13) Hospitals, seven (7) Maternity homes and twenty (20) Clinics were also interviewed. Data was collected with interviewer–administered questionnaires. STATA software (version 11) was used for cleaning, standardizing and analysing data.ResultsA majority, 97.9% of the clients interviewed had heard of capitation payment although this did not translate into their level of understanding. About two-thirds, 61.2% disclosed that capitation was not important to them as clients are restricted to one Preferred Primary Provider (PPP) for a long period of time. About 94% of health providers also believed that people did not like the capitation payment system due to their misconception that it has been politicized (34%); does not give clients free choice of providers (26%) and capitation not covering most drugs (17%).ConclusionAlthough awareness of the capitation was high among clients, attitudes towards the capitation payment system were somewhat poor. A good understanding of the capitation payment system is key to ensuring client and provider acceptance and smooth implementation of the system.