Ghana's Health Insurance Scheme Research Articles

Assessing Factors Affecting the Patronage of Health Insurance Schemes: An Evidence of Ghana

The Ghana Health Insurance Scheme was established to ensure enhancement in the quality of rudimentary health care services to all citizens. Notwithstanding the seemingly splendid financing structure, yet, there is empirical evidence of low enrolment. The study investigated the factors that have accounted for the truncated patronage of the health insurance scheme in Ghana. It also seeks to ascertain the factors that motivate individuals to join the scheme and finally examine the challenges of the scheme coverage expansion. The study used both interview, primary, and secondary data. The cross-sectional model was used to investigate the factors effects on NHIS. It was revealed that Income level, family characteristics, risk perception, and health care system delivery has an imperative negative influence on the low enrolment of the NHIS scheme in Ghana. However, questionnaires and interviews were used to find out from respondents and clients on the motivations and challenges associated with the scheme. The findings revealed that majority of the respondents agreed that access to free drugs is the strong arsenal that motivates individuals reluctant joining the scheme. The study further revealed that, majority of the respondents representing 87% have the notion that, negative attitude of the service providers at the health centers was the main barrier of the scheme among subscribers and non- subscribers in Ghana. Our results have practical implication that, intensive education should be enrolled out by the National Health Insurance Authority (NHIA) to change the negative perception of people in relation to the challenges among both subscribers and non-subscribers.

Multi-level and Multi-Actor Governance of National Health Insurance Scheme in Ghana: An exploration of the perceived challenges in the Bosumtwi District

National health insurance scheme has been used as a strategy to address health inequalities in Ghana in the past ten years. In ensuring all inclusive governance, the government has instituted a system which aims at bringing together various actors at all levels of government. However, little is known about the challenges involved in such multi-level and multi-actor system. In order to open this ‘black box’, we explored the views of those involved at the district levels to understand the challenges that are associated with this system of governance. We used face-to-face interviews and document review. The study area was Bosumtwi District and the sample size was 25 stakeholders. Data were recorded and later analysed. The findings of the study revealed some challenges which include: working with different set of stakeholders with incompatible interests and divergent goals; the existence of power differentials; limited opportunities for various stakeholders at lower levels to make independent decisions and finally, the problem of coordinated action . It was concluded that while the system is a laudable idea, it would be better if such system helps to bring various actors to existing hierarchical and state-centric apparatuses so as to enhance better coordination of ideas.

Trends and characteristics of enrolment in the National Health Insurance Scheme in Ghana: a quantitative analysis of longitudinal data

BackgroundIn 2004, Ghana started experimenting a National Health Insurance Scheme (NHIS) to reduce out-of-pocket payment for healthcare. Like many other social health insurance schemes in Africa, the NHIS is striving for universal health coverage (UHC). This paper examines trends and characteristics of enrolment in the scheme to inform policy decisions on attainment of UHC.MethodsWe conducted trend analysis of longitudinal enrolment data of the NHIS for the period, 2010–2017. Descriptive statistics were used to examine trends and characteristics of enrolment by geographical region and member groups.ResultsOver the 8-year period, the population enrolled in the scheme increased from 33% (8.2 million) to 41% (11.3 million) between 2010 and 2015 and dropped to 35% (10.3 million) in 2017. Members who renewed their membership increased from 44% to 75.4% between 2010 and 2013 and then dropped to 73% in 2017. On average, the urban regions had significantly higher number of new enrolments than the rural ones. Similarly, the urban and peri-urban regions recorded significantly higher number of renewals than the other regions. In addition, persons below the age of 18 years and the informal sector workers had significantly higher number of enrolment than any other member group.ConclusionsEnrolment in the NHIS is declining and there are significant differences among geographical regions and member groups. Managers of the NHIS need to enforce the mandatory enrolment provision in the Act governing the scheme, employ innovative strategies such as mobile phone application for registration and renewals and address delays in healthcare provider claims to improve enrolment.

Sustaining the National Health Insurance Scheme in Ghana: Perceptions and Experiences of Health Care Providers and Subscribers

The establishment of the National Health Insurance Scheme was as a consequence of government effort at adopting a sustainable health care financing system with the aim of achieving universal health coverage. This study therefore explored the perceptions and experiences of health care providers and subscribers regarding the sustenance of the NHIS in Ghana. The study employed a mixed method design using survey questionnaires and in-depth face-to-face interviews. The study revealed that NHIS had contributed to the revenue base of service providers and increased healthcare utilisation at provider centres. The inability of health care providers to provide essential medicines and perceived poor quality of health care were identified as challenges to subscribers. The study concludes that the NHIS has the potential of ensuring universal health coverage provided stakeholders make deliberate efforts at addressing the obvious sustainable threats identified.

Social Health Insurance and the Use of Formal and Informal Care in Developing Countries: Evidence from Ghana’s National Health Insurance Scheme

This paper studies the relationship between the use of formal and informal health care in a developing country setting by examining the introduction of a social health insurance scheme in Ghana. We estimate the effects of gaining coverage on changes in care seeking behaviour and show how these effects differ by age and wealth status. District-level differences in the implementation of the insurance scheme provide exogenous variation in access to insurance and allow us to address issues with selection into coverage. Results indicate that insurance access strongly increased use of formal care and reduced out-of-pocket expenditures on health services.

Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana

BackgroundThere is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana’s national health insurance scheme.MethodsData come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen’s parade of “dwarfs and a few giants” is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana.ResultsThere was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones.ConclusionIt is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana’s national health insurance scheme on impoverishment due to OOP healthcare payments.

Comparison of medicines management strategies in insurance schemes in middle-income countries: four case studies

BackgroundMany middle-income countries are scaling up health insurance schemes to provide financial protection and access to affordable medicines to poor and uninsured populations. Although there is a wealth of evidence on how high income countries with mature insurance schemes manage cost-effective use of medicines, there is limited evidence on the strategies used in middle-income countries. This paper compares the medicines management strategies that four insurance schemes in middle-income countries use to improve access and cost-effective use of medicines among beneficiaries.MethodsWe compare key strategies promoting cost-effective medicines use in the New Rural Cooperative Medical Scheme (NCMS) in China, National Health Insurance Scheme in Ghana, Jamkesmas in Indonesia and Seguro Popular in Mexico. Through the peer-reviewed and grey literature as of late 2013, we identified strategies that met our inclusion criteria as well as any evidence showing if, and/or how, these strategies affected medicines management. Stakeholders involved and affected by medicines coverage policies in these insurance schemes were asked to provide relevant documents describing the medicines related aspects of these insurance programs. We also asked them specifically to identify publications discussing the unintended consequences of the strategies implemented.ResultsUse of formularies, bulk procurement, standard treatment guidelines and separation of prescribing and dispensing were present in all four schemes. Also, increased transparency through publication of tender agreements and procurement prices was introduced in all four. Common strategies shared by three out of four schemes were medicine price negotiation or rebates, generic reference pricing, fixed salaries for prescribers, accredited preferred provider network, disease management programs, and monitoring of medicines purchases. Cost-sharing and payment for performance was rarely used. There was a lack of performance monitoring strategies in all schemes.ConclusionsMost of the strategies used in the insurance schemes focus on containing expenditure growth, including budget caps on pharmaceutical expenditures (Mexico) and ceiling prices on medicines (all four countries). There were few strategies targeting quality improvement as healthcare providers are mostly paid through fixed salaries, irrespective of the quality of their prescribing or the health outcomes actually achieved. Monitoring healthcare system performance has received little attention.

Assessing the catastrophic effects of out-of-pocket healthcare payments prior to the uptake of a nationwide health insurance scheme in Ghana

ABSTRACT Background: Financial risk protection against the cost of unforeseen healthcare has gained global attention in recent years. Although Ghana implemented a nationwide health insurance scheme with a goal of reducing financial barriers to accessing healthcare and addressing impoverishing effects of out-of-pocket (OOP) healthcare payments, there is a paucity of knowledge on the extent of financial catastrophe of such payments in Ghana. Thus, this paper assesses the catastrophic effect of OOP healthcare payments in Ghana. Methods: Ghana Living Standard Survey (GLSS 5) data collected in 2005/2006 are used in this study. Catastrophic effect of OOP healthcare payments is assessed using various thresholds of total household expenditure and non-food expenditure. Furthermore, four indices, namely the catastrophic payment headcount, catastrophic payment gap, weighted catastrophic payment headcount and weighted catastrophic payment gap, are defined and computed. Results: As at 2005/2006, it was estimated that 11.0% of households in Ghana spent over 5% of their total household expenditure on healthcare OOP. However, after adjusting for the concentration of such spending, it decreased to 10.9%. Also 10.7% of households spent more than 10% of their non-food consumption expenditure on OOP healthcare payments. Furthermore, about 2.6% of households are observed to have spent in excess of 20% of their total household income on healthcare OOP. With the exception of the 5% threshold of household expenditure, because the concentration indices of these expenditures are negative, the burden of such expenditures rests more on the poor. Conclusions: Significant levels of financial catastrophe existed in Ghana prior to the uptake of the national health insurance scheme. Poorer households were at a higher risk than the relatively well-off households. The results of this study present baseline assessment of the impact of Ghana’s health insurance policy on catastrophic healthcare payments. Thus, there is a need for continuous monitoring of financial catastrophe in the system to ensure that households are adequately protected.

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.

Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District

BackgroundGhana introduced the National Health Insurance Scheme (NHIS) in 2003 to provide financial access to health care for all residents. ObjectivesThis article analyzed claims reimbursement data of the NHIS to assess the value of the benefit package to the insured and responsiveness of the service to the financial needs of health services providers. MethodsMedical claims data reported between January 1, 2010, and December 31, 2014, were retrieved from the database of Ashiedu Keteke District Office of the National Health Insurance Authority. The incurred claims ratio, promptness of claims settlements, and claims adjustment rate were analyzed over the 5-year period. ResultsIn all, 644,663 medical claims with a cost of Ghana cedi (GHS) 11.8 million (US $3.1 million) were reported over the study period. The ratio of claims cost to contributions paid increased from 4.3 to 7.2 over the 2011-2013 period, and dropped to 5.0 in 2014. The proportion of claims settled beyond 90 days also increased from 26% to 100% between 2011 and 2014. Generally, the amount of claims adjusted was low; however, it increased consistently from 1% to about 4% over the 2011-2014 period. The reasons for claims adjustments included provision of services to ineligible members, overbilling of services, and misapplication of diagnosis related groups. ConclusionsThere is increased value of the NHIS benefit package to subscribers; however, the scheme’s responsiveness to the financial needs of health services providers is low. This calls for a review of the NHIS policy to improve financial viability and service quality.

Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana.

Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghana's National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts.

Enrolment on Health Insurance Scheme in Ghana: Evidence from Mfantseman Municipality

The study aimed at analysing the determinants of enrolment in the Ghana’s national health insurance scheme. This survey was carried out to collect cross-sectional information from a representative sample of 384 households using a pre-tested interviewer-administered questionnaire. Multistage sampling procedure was used to select the respondents. Binary logit model was used to estimate the determinants of enrolment to the scheme. The findings show that factors such as age, occupation, place of residence, income and wealth, play an important role in shaping individuals’ and households’ decision to enrol. Additionally, sex, marital status, household size, and distance significantly influenced individual’s decision to enrol whereas education influences household enrolment. It is recommended that appropriate educational packages be organised for the citizenry to encourage families to enrol, as the scheme prevents impoverishment resulting from catastrophic health expenditures and also improves access to healthcare. Targeted demand-side subsidy for the indigents would contribute to welfare gain and could help government achieve universal healthcare coverage. Keywords : National Health Insurance Scheme, Determinants, Enrolment, Healthcare and Ghana

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

BackgroundQuality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge.PurposeTo examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed.MethodsThis is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman’s rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare.ResultsNegative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities.ConclusionThere is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana’s healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.

Participatory action approach for client-centered health insurance

This methodological paper systematically describes the steps towards exploring client-perceived barriers to enroll in the National Health Insurance Scheme in Ghana. To respond to the stagnating enrollment rate and to provide evidence-based information for developing policy and practice, the request for this study was made by the insurance authority. We adopted a Participatory Action Approach (PAA) and employed a linked trajectory of qualitative and quantitative methods to inquire deeply into clients’ motives and assumptions, and the root causes of these barriers, while transferring learning among multiple stakeholders in the system: the client, the healthcare provider, and the insurer. Data were collected in 2011 and 2012 among clients in their local communities in two regions in Ghana. Clients were participants in the research, expressing and sharing their emic perspectives and commonly shared opinions with the other stakeholders. This paper explores the contribution of the PAA to healthcare and health insurance studies. We claim that the PAA is a necessary approach for the study of a complex situation such as the health insurance context in Ghana as well as for the facilitation of learning and democratic decision-making. Making multidisciplinary stakeholders, including clients, part of the research contributes to finding solutions that are acceptable to different stakeholders. Our study contributes to PAA methodology knowledge and provides new insights on combining qualitative and quantitative research methods. We propose this as a model to be used within action research that can also be applied in other contexts outside of Africa.

Factors influencing the decision to drop out of health insurance enrolment among urban slum dwellers in Ghana.

To identify the factors influencing dropout from Ghana's health insurance scheme among populations living in slum communities. Cross-sectional data were collected from residents of 22 slums in the Accra Metropolitan Assembly. Cluster and systematic random sampling techniques were used to select and interview 600 individuals who had dropped out from the scheme 6months prior to the study. Descriptive statistics and multivariate logistic regression models were computed to account for sample characteristics and reasons associated with the decision to dropout. The proportion of dropouts in the sample increased from the range of 6.8% in 2008 to 34.8% in 2012. Non-affordability of premium was the predominant reason followed by rare illness episodes, limited benefits of the scheme and poor service quality. Low-income earners and those with low education were significantly more likely to report premium non-affordability. Rare illness was a common reason among younger respondents, informal sector workers and respondents with higher education. All subgroups of age, education, occupation and income reported nominal benefits of the scheme as a reason for dropout. Interventions targeted at removing bottlenecks to health insurance enrolment are salient to maximising the size of the insurance pool. Strengthening service quality and extending the premium exemption to cover low-income families in slum communities is a valuable strategy to achieve universal health coverage.

Determinant of factors associated with child health outcomes and service utilization in Ghana: multiple indicator cluster survey conducted in 2011.

BackgroundThe effects of National Health Insurance Scheme in Ghana and its impact on child health outcome and service utilization cannot be underestimated. Despite the tremendous improvement in child health care in Ghana, there are still some challenges in relation to how National health insurance membership, socioeconomic status and other demographic factors impacts on child health outcomes. The study seeks to determine the association between NHIS membership, socio-economic status, geographic location and other relevant background factors, on child health service utilization and outcomes.MethodsSecondary data from the Multiple Indicator Cluster Survey conducted in 2011 was used. Multivariate analysis based on Binary Logistic Regression Models and Multiple linear regression techniques was applied to determine factors associated with child health outcomes and service utilization. Collection of best models was based on Hosmer-Lemeshow Goodness-Of-Fit as one criterion of fit and the Akaike Information Criterion.ResultsControlling for confounding effect of socioeconomic status, age of the child, mothers education level and geographic location, the odds of a child developing anemia for children with National Health Insurance Scheme Membership is 65.2% [95% CI: 52.9-80.2] times less than children without National Health Insurance Scheme Membership. The odds of being fully immunized against common childhood illnesses for children with NHIS membership is 2.3[95% CI: 1.4-3.7] times higher than children without National Health Insurance Scheme Membership. There was no association between National Health Insurance Scheme Membership and stunted growth in children.ConclusionsNational Health Insurance Scheme Membership was found to be related to child health service utilization (full immunization) of children under five a child’s anemia status. Children with NHIS are more likely to be fully immunized against common childhood diseases and are less likely to develop anemia. Stunted growth of children was not associated with National Health Insurance Scheme Membership. Health Education on the registration and the use of the National Health Insurance should be made a national priority to enable the Ministry of Health achieve routine Immunization targets and to reduce to the bearers minimum prevalence of anemia.

Claims Reimbursement Analysis of the National Health Insurance Scheme in Ghana.

Claims Reimbursement Analysis of the National Health Insurance Scheme in Ghana.

The National Health Insurance Scheme in Ghana's Upper West Region: A gendered perspective of insurance acquisition in a resource-poor setting

Ghana's National Health Insurance Scheme (NHIS) was designed as a pro-poor strategy to create wider access to health care. While recent studies have shown that wealth is an important factor in enrolment in the scheme, there is little understanding of its interlinkages with the geographical divisions and deep-seated deprivation in the northern region. In response to the nexus of poverty, gender and access to health care, this research took place in Ghana's Upper West Region (UWR), one of the poorest regions and yet paradoxically touting the highest enrolment rates. Using data from a population survey (n = 2119) collected between May to December 2011, we used multinomial regression to examine factors that influence enrolment, controlling for theoretically relevant covariates. Findings reveal that although wealth and desire for health insurance are contributing factors, education was the primary determinant in both never enrolling and in dropping out, and that these factors impact men and women differently. The study also shows that Muslims were less likely to enrol and also women living in non-nuclear households were far more likely to dropout. Our results demonstrate clear gendered divisions in accessing the NHIS, and raised serious equity concerns in the UWR. By focussing on the context of the UWR, we show the importance of understanding intra-household bargaining and resource allocation via the gender dynamics related to health insurance procurement and maintenance, and discuss associated policy implications.

Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

Introduction The Government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to replace out-of-pocket (OOP) payment for health services with the inherent aim of reducing the direct cost of treating illness to households. Objective To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana. Methods We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective. Results Of the 4,226 households visited, a total of 1,324 (31%) household members reported fever and 51% (675) reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424), with the remainder either self-medicating with drugs from chemical shops 32% (217) or with leftover drugs or herbs 5% (34). Most of those who sought care from formal health facilities were insured 79% (334). The average direct medical cost of treating malaria was GH¢3.2 (US$2.1) per case with the insured spending less (GH¢2.6/US$1.7) per case than the uninsured (GH¢3.2/US$2.1). The overall average cost (direct and indirect) incurred by households per malaria treatment was GH¢20.9 (US$13.9). Though the insured accounted for a larger proportion of admissions at health facilities 76% (31) than the uninsured 24% (10), the average amount households spent on the insured was less (GH¢4/US$2.7) than their uninsured counterparts (GH¢6.4/US$4.3). The difference was not statistically significant (p=0.2330). Conclusion Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect on cost (outpatient and in-patient) of malaria treatment.

The National Health Insurance Scheme in Ghana: Implementation Challenges and Proposed Solutions

Healthcare financing through social health insurance has become a very important tool in providing access to and utilization of health services in most developing countries such as Ghana. Ghana’s National Health Insurance Scheme (NHIS) is a promising tool for policymakers. Yet since its inception in 2003, few studies have assessed the scheme.This paper aims to explore the challenges facing the District Mutual Health Insurance Schemes (DMHISs), how these challenges have been managed over the years, and what can be done to improve the DMHIS operation. The scope of this study is to improve policies and guide support for Ghanaian DMHISs as well as to provide recommendations when implementing future NHISs in a developing-country context.