Introduction Of National Health Insurance Scheme Research Articles

Challenges of Health Care Delivery at a Municipal Health Facility under Ghana’s National Health Insurance Scheme

Introduction: Empirical evidence on challenges to health care delivery at district/municipal level under the National Health Insurance Scheme (NHIS) in Ghana is limited. This study determined challenges to optimal health care delivery at a municipal hospital underGhana’s NHIS.Method: A cross-sectional study was undertaken between January-March 2010 at the Winneba Municipal Hospital (WHM) in Ghana to review out-patients (OPD) records from 2005- 2008. A structured questionnaire was used to collect data from 345 outpatients(170 insured and 175 uninsured), and from their folders. Eleven key informants from the WMH were interviewed.Results: The NHIS was introduced at the WMH in 2006, resulting in an increased OPD attendance of 77.3% in 2007. Insured clients visited the OPD many times and at shorter intervals than uninsured clients. Disease patterns at the OPD were however similarbefore and after the introduction of NHIS at the Hospital. Key health providers at the WMH admitted to increasing OPD numbers and prolonged client waiting times. Over 40% of insured clients spent three hours or more to receive OPD services. Financial support fromthe Government to the WMH has reduced since the introduction of NHIS. In 2008, over 70% of total hospital revenue was from the NHIS; delays in payment by District/Municipal Mutual Health Insurance Schemes (DMHIS) significantly strained hospital financesand provision of drugs and supplies.Conclusions: Increased OPD numbers, prolonged client waiting times, consumer moral hazard, limited Government financial support and delayed NHIS funds were critical challenges at the WMH. Innovative measures to limit moral hazard (i.e. reward mechanismsfor non-frequent visits, and introduction of copayments for multiple visits) are recommended. Means to improve the skills of hospital staff dealing with NHIS and staff of the DMHIS are policies worth pursuing.

Effect of the National Health Insurance Scheme on Community-Based Health Planning and Services in the Vieri Zone of Wa West District of Ghana

Ghana launched the Community-based Health Planning and Services (CHPS) initiative in the year 2000 in furtherance of the ideals of primary health care. The CHPS strategy was adopted by the MOH as a national programme to bridge the gap in access to healthcare. It provides for a Community Health Officer (CHO) to be resident in a community and with the help and support of the community members, to render some basic packages of PHC especially preventive services including home visiting, educational programmes and other health promotion activities and not sedentary clinical services at the health facility. With the introduction of the National Health Insurance Scheme (NHIS), which is a form of Health care financing in order to serve as a conduit for providing financial access to health care. This has perceptively resulted in an increase in out-patient attendance at all facilities especially CHPS facilities. This tended to constrain the CHOs from embarking on their mandated task of home visitation, educational programmes and other health promotion packages. It is against this background that this research work has been carried out to ascertain why the focus of CHPS is shifting from a preventive to a curative approach. The methodology adopted was a case study using a before and after approach to make comparison of the preventive health care activities of the CHO before and after the introduction of NHIS as well as access of people to the Vieri CHPS compound. Simple random sampling was used to select 165 households who were interviewed. We purposively sampled CHOs, the Community Health Management Committee (CHMC) and Community Health Volunteers (CHVs) who have in-depth knowledge on the operations of the CHPs. The study revealed that the frequency of household visitation and the educational programmes organized by the CHOs have declined. This is due to the net effect of NHIS on the facility and the CHOs due to increased attendance at the facility. This did not only negatively affect the activities that the CHOs are supposed to carrying out but also on the health infrastructure. The study also revealed various challenges faced by CHMCs and CHVs.

A comparative study of quality of care before and after introduction of National Health Insurance Scheme in health facilities in Zaria, Kaduna State, Northwestern Nigeria

Background: The National Health Insurance Scheme (NHIS) in Nigeria was introduced in 2005 to remove financial barriers to access of care and to improve quality of care. However, since introduction of the scheme, there has not been any documented study to assess whether there has any improvement in quality of care in the participating facilities as a result of its introduction. Objectives: This study was undertaken to determine and compare the quality of care before and after introduction of NHIS in health facilities in Zaria, Kaduna State, Northwestern Nigeria. Materials and Methods: The study was cross-sectional, descriptive, and comparative in design. Using stratified sampling one public and two private NHIS accredited secondary health facilities were selected. Adherence to Federal Ministry of Health performance standards for emergency obstetric care was used as proxy for quality. A retrospective analysis of a total of 320 case notes of female patients that were managed in these facilities for five maternal complications was undertaken, 160 before and 160 after introduction of NHIS. Results: Results showed that quality of care, represented by levels of adherence to standard treatment guidelines, was generally poor (42%). The mean adherence to standards of care levels at facility level of 37.9% before and 46.3% after introduction of NHIS was observed; this difference was statistically significant (P = 0.005), with the public facility performing significantly better, with an adherence level of 59% compared to 30% for private facilities (P = 0.001). Conclusion: The study demonstrated improvement in quality of care following introduction of NHIS in the facilities. Integrating supportive supervision and rapid expansion of the scheme are recommended to widely spread its quality-related benefits.

Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?

BackgroundUganda is proposing introduction of the National Health Insurance scheme (NHIS) in a phased manner with the view to obtaining additional funding for the health sector and promoting financial risk protection. In this paper, we have assessed the proposed NHIS from an equity perspective, exploring the extent to which NHIS would improve existing disparities in the health sector.MethodsWe reviewed the proposed design and other relevant documents that enhanced our understanding of contextual issues. We used the Kutzin and fair financing frameworks to critically assess the impact of NHIS on overall equity in financing in Uganda.ResultsThe introduction of NHIS is being proposed against the backdrop of inequalities in the distribution of health system inputs between rural and urban areas, different levels of care and geographic areas. In this assessment, we find that gradual implementation of NHIS will result in low coverage initially, which might pose a challenge for effective management of the scheme. The process for accreditation of service providers during the first phase is not explicit on how it will ensure that a two-tier service provision arrangement does not emerge to cater for different types of patients. If the proposed fee-for-service mechanism of reimbursing providers is pursued, utilisation patterns will determine how resources are allocated. This implies that equity in resource allocation will be determined by the distribution of accredited providers, and checks put in place to prohibit frivolous use. The current design does not explicitly mention how these two issues will be tackled. Lastly, there is no clarity on how the NHIS will fit into, and integrate within existing financing mechanisms.ConclusionUnder the current NHIS design, the initial low coverage in the first years will inhibit optimal achievement of the important equity characteristics of pooling, cross-subsidisation and financial protection. Depending on the distribution of accredited providers and utilisation patterns, the NHIS could worsen existing disparities in access to services, given the fee-for-service reimbursement mechanisms currently proposed. Lastly, if equity in financing and resource allocation are not explicit objectives of the NHIS, it might inadvertently worsen the existing disparities in service provision.