National Health Insurance Authority Research Articles

Managing and Predicting the Number of Health Insurance Claims in Ghana Based on Big Data and Time Series Analysis: A Case Study of Kumasi Metropolis, Ghana

This study seeks to improve the process of managing and securing personal information (name, age, place of residence, telephone number, disease and so on) of the National Health Insurance Scheme (NHIS) subscribers of Ghana. Data was collected from the National Health Insurance Authority (NHIA) in Kumasi, Ghana on claims dating from 2010 to 2016. Big data methodology and Seasonal Auto Regressive Integrated Moving Average (SARIMA) model was used to study and analyze the trend of health insurance claims and its future prediction claims.Our result showed an overall decrease in the number of claims from 2010 to 2016 and revealed that, the NHIA is faced with challenges in handling claims submitted to it by its clientele. An increasing trend was predicted from 2017 to 2022based on the model. Henceforth, the challenges of NHIA from the results of our study are attributable to inflated claims by clientele. NHIA efficiency can be improved by establishing a system that validates and controls claims.

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.

Seeking healthcare under the National Health Insurance Scheme’s capitation payment method in Wa Municipality, Ghana: Subscribers’ perspectives

The National Health Insurance Scheme (NHIS) in Ghana has three key stakeholders: National Health Insurance Authority, preferred primary providers (PPP) and subscribers. Since the introduction of the capitation payment method (CPM), research has focused on the NHIS and care providers with little attention on subscribers as stakeholders of the policy. This study sought to solicit the perspectives of the NHIS subscribers on the prospects and challenges of the NHIS CPM. Survey design was employed in this study involving 135 subscribers who were conveniently selected at 11 health facilities. Questionnaires were used to collect the data which were analyzed using the Statistical Package for Social Sciences (SPSS). The results show that subscribers have little knowledge on how the CPM works as serious efforts have not been made to adequately educate the public on the policy. It was also found that subscribers were not able to obtain quality drugs from their PPPs due to the fact that some drugs which previously were on the NHIS drug list have been removed. This paper concludes that subscribers were ill-informed about the CPM even though it has the potential to improve access to health history of subscribers which is critical in providing quality healthcare.

Is Enrolment in the National Health Insurance Scheme in Ghana Pro-Poor? Evidence from the Ghana Living Standard Survey

Background: Earlier studies have found enrolment in the Ghana National Health Insurance Scheme (NHIS) as pro-rich. In recent years, the NHIS has embarked on aggressive enrolment of the poor and vulnerable to reverse the trend. This article examines equity in enrolment in the NHIS to inform policy decisions on progress towards realisation of universal health coverage (UHC). Methods: Secondary analysis of data from the sixth round of the Ghana Living Standards Survey (GLSS 6). The survey was conducted between 18 October 2012 and 17 October 2013 with 16,774 household heads. Equity in enrolment was assessed using concentration curves and bivariate and multivariate analyses to determine associated factors. Findings: Survey participants had a mean age of 46 years and mean household size of four persons. About 71% of households interviewed had at least one person enrolled in the NHIS. Households in the poorest wealth quintile (73%) had enrolled significantly (p<0.001) more than those in the richest quintile (67%). The concentration curves further showed that enrolment was slightly disproportionally concentrated among poor households, particularly those headed by males. However, multivariate logistic analyses showed that the likelihood of NHIS enrolment increased from poorer to richest quintile and from low to high level of education. Other factors including age, sex, household size, household setting, and geographic region were significantly associated with enrolment. Interpretations: From 2012-2013 enrolment in the NHIS was higher among poor households, particularly male-headed households, although multivariate analyses demonstrated that the likelihood of NHIS enrolment increased from poorer to richest quintile and from low to high level of education. Policy makers need to ensure equity within and across gender as they strive to achieve UHC. Funding Statement: The authors declare: None. Declaration of Interests: ENB is an employee of the National Health Insurance Authority, however his affiliation did not influence findings of this study. JPR and JN declare no competing interests. Ethics Approval Statement: Not Required.

Does a provider payment method affect membership retention in a health insurance scheme? a mixed method study of Ghana\u2019s capitation payment for primary care

BackgroundGhana introduced a National Health Insurance Scheme (NHIS) in 2003 applying fee-for-service method for paying NHIS-credentialed health care providers. The National Health Insurance Authority (NHIA) later introduced diagnosis-related-grouping (DRG) payment to contain cost without much success. The NHIA then introduced capitation payment, a decision that attracted complaints of falling enrolment and renewal rates from stakeholders. This study was done to provide evidence on this trend to guide policy debate on the issue.MethodsWe applied mixed method design to the study. We did a trend analysis of NHIS membership data in Ashanti, Volta and Central regions to assess growth rate; performed independent-sample t-test to compare sample means of the three regions and analysed data from individual in-depth interviews to determine any relationship between capitation payment and subscribers’ renewal decision.ResultsResults of new enrolment data analysis showed differences in mean growth rates between Ashanti (M = 30.15, SE 3.03) and Volta (M = 40.72, SE 3.10), p = 0.041; r = 0. 15; and between Ashanti and Central (M = 47.38, SE6.49) p = 0.043; r = 0. 42. Analysis of membership renewal data, however, showed no significant differences in mean growth rates between Ashanti (M = 65.47, SE 6.67) and Volta (M = 69.29, SE 5.04), p = 0.660; r = 0.03; and between Ashanti and Central (M = 50.51, SE 9.49), p = 0.233. Analysis of both new enrolment and renewal data also showed no significant differences in mean growth rates between Ashanti (M = − 13.76, SE 17.68) and Volta (M = 5.48, SE 5.50), p = 0.329; and between Ashanti and Central (M = − 6.47, SE 12.68), p = 0.746. However, capitation payment had some effect in Ashanti compared with Volta (r = 0. 12) and Central (r = 0. 14); but could not be sustained beyond 2012. Responses from the in-depth interviews did not also show that capitation payment is a key factor in subscribers’ renewal decision.ConclusionCapitation payment had a small but unsustainable effect on membership growth rate in the Ashanti region. Factors other than capitation payment may have played a more significant role in subscribers’ enrolment and renewal decisions in the Ashanti region of Ghana.

Factors That Influence Enrolment and Retention in Ghana' National Health Insurance Scheme.

Background: The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2004 with the goal of achieving universal coverage within 5 years. Evidence, however, shows that expanding NHIS coverage and especially retaining members have remained a challenge. A multilevel perspective was employed as a conceptual framework and methodological tool to examine why enrolment and retention in the NHIS remains low. Methods: A household survey was conducted after 20 months educational and promotional activities aimed at improving enrolment and retention rates in 15 communities in the Central and Eastern Regions (ERs) of Ghana. Observation, indepth interviews and informal conversations were used to collect qualitative data. Forty key informants (community members, health providers and district health insurance schemes’ [DHISs] staff) purposely selected from two casestudy communities in the Central Region (CR) were interviewed. Several community members, health providers and DHISs’ staff were also engaged in informal conversations in the other five communities in the region. Also, four staff of the Ministry of Health (MoH), Ghana Health Service (GHS) and National Health Insurance Authority (NHIA) were engaged in in-depth interviews. Descriptive statistics was used to analyse quantitative data. Qualitative data was analysed using thematic content analysis. Results: The results show that factors that influence enrolment and retention in the NHIS are multi-dimensional and cut across all stakeholders. People enrolled and renewed their membership because of NHIS’ benefits and health providers’ positive behaviour. Barriers to enrolment and retention included: poverty, traditional risk-sharing arrangements influence people to enrol or renew their membership only when they need healthcare, dissatisfaction about health providers’ behaviour and service delivery challenges. Conclusion: Given the multi-dimensional nature of barriers to enrolment and retention, we suggest that the NHIA should engage DHISs, health providers and other stakeholders to develop and implement intervention activities to eliminate corruption, shortage of drugs in health facilities and enforce the compulsory enrolment stated in the NHIS policy to move the scheme towards universal coverage.

Migrant female head porters\u2019 enrolment in and utilisation and renewal of the National Health Insurance Scheme in Kumasi, Ghana

PurposeAs a social protection policy, Ghana’s National Health Insurance Scheme (NHIS) aims to improve access to healthcare, especially for the vulnerable. Migrant female head porters (kayayoo), who are part of the informal economic workforce, are underscored as an ethnic minority and vulnerable group in Ghana. This study aimed to analyse the factors associated with enrolment in and renewal and utilisation of the NHIS among migrant female head porters in the Kumasi Metropolis.MethodWe purposively sampled 392 migrant female head porters in the Kejetia, Asafo and Bantama markets. We used a binary logit regression model to estimate associations among baseline characteristics, convenience and benefit factors and enrolment in and renewal and utilisation of the NHIS.ResultAge and income significantly increased the probability of NHIS enrolment, renewal and utilisation. Long waiting times at NHIS offices significantly reduced the likelihood of renewal, while provision of drugs highly significantly increased the tendency for migrant female head porters to enrol in, renew and use the NHIS. Consulting and surgery also significantly increased renewal and utilisation of the NHIS.ConclusionPolitical commitment is imperative for effective implementation of the decentralisation policy of the NHIS through the National Health Insurance Authority in Kumasi. We argue that retail offices should be well equipped with logistic facilities to ensure convenience in NHIS initial enrolment and renewal processes by citizenry, and by vulnerable groups in particular.

Barriers and motivations for health insurance subscription in Cape Coast, Ghana: a qualitative study

BackgroundOne of the main objectives of the Ghana National Health Insurance Scheme, at its establishment in 2003, was to ease financial burden of the full cost recovery policy, particularly on the poor. However, currently, majority of the scheme’s subscribers are individuals in the upper wealth quintile, as the poor in society rather have not subscribed. We explored the motivational factors as well as the barriers to health insurance subscription in the Cape Coast Metropolis of Ghana.MethodsThis study collected qualitative data from 30 purposively selected subscribers and non-subscribers to the National Health Insurance Scheme using an in-depth interview guide.ResultsMajor motivational factors identified were; affordable health insurance premium, access to free drugs, and social security against unforeseen health challenges. Encouragement by friends, family members, and colleagues, was also found to motivate subscription to the health insurance. The major barriers to health insurance subscription included; long queues and waiting time, perceived poor quality of drugs, and negative attitude of service providers both at the healthcare facilities and the health insurance office. The study underscores the need for the National Health Insurance Authority to conduct intensive education to change the negative perception people have regarding the quality of health insurance drugs. Efforts should also be made to reduce the waiting time in accessing healthcare with the National Health Insurance Scheme card. This would motivate more people to subscribe or renew their membership.ConclusionsThe implication of barriers found is that people may not subscribe to the scheme in subsequent years. This would, therefore, consequently defeat the objective of achieving universal healthcare coverage with the scheme.

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.

The Cost-Effectiveness of Entresto™ (Sacubitril and Valsartan) Compared with Enalapril in Managing Chronic Heart Failure in Ghana: Decision Analytic Modelling

Background: Over the years, Angiotensin-converting enzyme inhibitors (ACEis) and Angiotensin Receptor Blockers (ARBs) have been the groups of medications of choice for managing Chronic Heart Failure (CHF). However, Entresto™, a formulation of Sacubitril and Valsartan has shown to be of superior effectiveness and thus, approved for use in many countries. Nonetheless, there is a limited economic evaluation of Entresto™ in Low-and-Middle Income Countries (LMICs), leaving significant gaps in the body of evidence supporting its cost-effectiveness. Objective: To model the lifetime cost-effectiveness of Entresto™ as compared to Enalapril in the treatment of a cohort of 42-year old patients with stage II-IV CHF with reduced ejection fraction, from the health system perspective. Methods: A three-state Markov model was developed to simulate the long-term outcomes and costs of care for a hypothetical cohort of 42-year-old patients with CHF who were assumed to receive either Entresto™ plus recommended therapy or Enalapril plus recommended therapy (standard care). One-way sensitivity analysis was conducted using a best and worst case scenario analysis while probabilistic sensitivity analysis was done using beta distribution around the input parameters. Results: The results show that after 30 years, more patients taking Enalapril died as compared with those taking Entresto™ (85.3% vs. 96.5%) but the lifetime cost of Entresto™ treatment was higher than Enalapril [US$44,656.13 (GH¢192,021.35) vs. US$922.99 (GH¢3,968.86)]. Also, Entresto™ as compared with Enalapril, yielded higher QALYs (7.59 vs. 5.33) culminating in an Incremental Cost Effectiveness Ratio (ICER) of US$19,343 (GH¢83,175.08) per QALY which may be deemed not cost-effective based on an assumed Willingness to Pay (WTP) threshold of US$5,121 (three times Gross Domestic Product Per Capita). Conclusion: In the context of Ghana, with maximum WTP threshold of US$5,121 per QALY (threefold per capita GDP), Entresto™ is not deemed a cost-effective alternative to Enalapril unless its US market price of US$380 per monthly pack is reduced by at least 73% or the WTP threshold is raised above US$10,000 per QALY. The National Health Insurance Authority (NHIA) and the Ghana National Drugs Programme (GNDP) should consider engaging the manufacturers of Entresto™ for a possible price reduction or secure a subsidy from the government or both to make the drug available for Ghanaian CHF patients.

Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana

BackgroundIn 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana’s health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC.MethodsUsing qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers.A stakeholders’ workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from respondents for the achievement of the goals of UHC and PHC.ResultsThe key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS; inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC.ConclusionThis study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC.

Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana.

BackgroundThe population of Ghana is increasingly becoming urbanized with about 70 % of the estimated 26.9 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32.1 % of the national health sector workforce works. Doctor-patient ratio in a predominantly rural region is about 1:18,257 compared to 1:4,099 in an urban region. These rural–urban inequities significantly account for the inability of Ghana to attain the health related Millennium Development Goals (MDGs) before the end of 2015.PurposeTo ascertain whether or not rural-urban differences exist in health worker motivation levels and quality of health care in health facilities accredited by the National Health Insurance Authority in Ghana.MethodsThis is a baseline quantitative study conducted in 2012 among 324 health workers in 64 accredited clinics located in 9 rural and 7 urban districts in Ghana. Ordered logistic regression was performed to determine the relationship between facility geographic location (rural/urban) and staff motivation levels, and quality health care standards.ResultsQuality health care and patient safety standards were averagely low in the sampled health facilities. Even though health workers in rural facilities were more de-motivated by poor availability of resources and drugs than their counterparts in urban facilities (p < 0.05), quality of health care and patient safety standards were relatively better in rural facilities.ConclusionFor Ghana to attain the newly formulated sustainable development goals on health, there is the need for health authorities to address the existing rural–urban imbalances in health worker motivation and quality health care standards in primary healthcare facilities. Future studies should compare staff motivation levels and quality standards in accredited and non-accredited health facilities since the current study was limited to health facilities accredited by the National Health Insurance Authority.

Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana.

BackgroundIn 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana’s health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC.MethodsUsing qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers.A stakeholders’ workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from participants for the achievement of the goals of UHC and PHC.ResultsThe key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS, inadequate coordination among stakeholders in PHC delivery; and inadequate funding for PHC, particularly on preventive and promotive services. Other areas are: the bypassing of PHC facilities due to lack of basic services at the PHC level such as laboratory services, as well as proximity to the district hospitals; and finally the lack of clear understanding of the national policy on PHC.ConclusionThis study suggests that despite the progress that has been made since the establishment of the NHIS in Ghana, there are still huge gaps that need urgent attention to ensure that the goals of UHC and PHC are met. The key areas of misalignment identified in this study, particularly on the delays in reimbursements need to be taken seriously. It is also important for more dialogue between the NHIA and service providers to address key concerns in the implementation of the NHIS which is key to achieving UHC.

Performance Assessment of the Juaboso District Office of the National Health Insurance Authority

ObjectivesTo assess the performance of the National Health Insurance Authority (NHIA) in Ghana. MethodsUsing a thorough case study of the Juaboso District Office of the NHIA, this study assessed the community coverage rate, the annual expenditure and income, and the trend of claims payment for the period 2009 to 2012 as well as factors influencing the level of patronage of the National Health Insurance Scheme. A self-administered structured questionnaire was used to gather data from the management of the scheme. Secondary data were also gathered from the scheme’s audited financial statements. Informal discussions were held with the premium collectors and clients to throw more light on revenue generation challenges. ResultsThe study found an increasing trend in the coverage rate on a yearly basis. Over the study period, the rate moved from 30.6 to 60.1, representing an increase of 96.7%. This shows that in terms of coverage rate, the Juaboso District Office of the NHIA is performing very well. The study also found that revenue has increased but the percentage rate of increase has decreased, compared with the coverage percentage rate. Expenditure has been on the rise, increasing by as much as 20.7% in 2011. Again, the study revealed a consistent year-on-year increase in the claims payment, consistent with the national trend. ConclusionsConstant clinical auditing of claims payments is required to ensure accountability. This would lead to transparency with regard to performance assessment of the claims. The findings have important implications for the effective management of the NHIA.

Health insurance subscription among women in reproductive age in Ghana: do socio-demographics matter?

BackgroundPremised that health insurance schemes in Africa have only been introduced recently and continue evolving, various concerns have been raised regarding their effectiveness in improving utilisation of orthodox health care and the reduction of out-of-pocket expenditures for their population, particularly women.ObjectiveTo examine the effects of socio-demographics on health insurance subscription among women in Ghana.MethodsThe study draws on the 2014 Ghana Demographic and Health Survey. Bivariate descriptive analysis and binary logistic regression were used to analyse the data.ResultsWealth status, age, religion, birth parity, marriage and ecological zone were found to have significantly predicted health insurance subscription among women in reproductive age in Ghana. Urban dwellers, women who are nulliparous, those with no or low levels of education, African traditionalists and the poor were those who largely did not subscribe to the scheme.ConclusionThe findings underscore the need for the National Health Insurance Authority to carry out more education in association with the National Commission for Civic Education and the Information Services Department to recruit more urban dwellers, nulliparous women, those with no or low levels of education, African traditionalists and the poor unto the scheme.

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.

Efficiency of private and public primary health facilities accredited by the National Health Insurance Authority in Ghana.

BackgroundDespite improvements in a number of health outcome indicators partly due to the National Health Insurance Scheme (NHIS), Ghana is unlikely to attain all its health-related millennium development goals before the end of 2015. Inefficient use of available limited resources has been cited as a contributory factor for this predicament. This study sought to explore efficiency levels of NHIS-accredited private and public health facilities; ascertain factors that account for differences in efficiency and determine the association between quality care and efficiency levels.MethodsThe study is a cross-sectional survey of NHIS-accredited primary health facilities (n = 64) in two regions in southern Ghana. Data Envelopment Analysis was used to estimate technical efficiency of sampled health facilities while Tobit regression was employed to predict factors associated with efficiency levels. Spearman correlation test was performed to determine the association between quality care and efficiency.ResultsOverall, 20 out of the 64 health facilities (31 %) were optimally efficient relative to their peers. Out of the 20 efficient facilities, 10 (50 %) were Public/government owned facilities; 8 (40 %) were Private-for-profit facilities and 2 (10 %) were Private-not-for-profit/Mission facilities. Mission (Coef. = 52.1; p = 0.000) and Public (Coef. = 42.9; p = 0.002) facilities located in the Western region (predominantly rural) had higher odds of attaining the 100 % technical efficiency benchmark than those located in the Greater Accra region (largely urban). No significant association was found between technical efficiency scores of health facilities and many technical quality care proxies, except in overall quality score per the NHIS accreditation data (Coef. = −0.3158; p < 0.05) and SafeCare Essentials quality score on environmental safety for staff and patients (Coef. = −0.2764; p < 0.05) where the association was negative.ConclusionsThe findings suggest some level of wastage of health resources in many healthcare facilities, especially those located in urban areas. The Ministry of Health and relevant stakeholders should undertake more effective need analysis to inform resource allocation, distribution and capacity building to promote efficient utilization of limited resources without compromising quality care standards.

Social capital and active membership in the Ghana National Health Insurance Scheme - a mixed method study.

BackgroundPeople’s decision to enroll in a health insurance scheme is determined by socio-cultural and socio-economic factors. On request of the National health Insurance Authority (NHIA) in Ghana, our study explores the influence of social relationships on people’s perceptions, behavior and decision making to enroll in the National Health Insurance Scheme. This social scheme, initiated in 2003, aims to realize accessible quality healthcare services for the entire population of Ghana. We look at relationships of trust and reciprocity between individuals in the communities (so called horizontal social capital) and between individuals and formal health institutions (called vertical social capital) in order to determine whether these two forms of social capital inhibit or facilitate enrolment of clients in the scheme. Results can support the NHIA in exploiting social capital to reach their objective and strengthen their policy and practice.MethodWe conducted 20 individual- and seven key-informant interviews, 22 focus group discussions, two stakeholder meetings and a household survey, using a random sample of 1903 households from the catchment area of 64 primary healthcare facilities. The study took place in Greater Accra Region and Western Regions in Ghana between June 2011 and March 2012.ResultsWhile social developments and increased heterogeneity seem to reduce community solidarity in Ghana, social networks remain common in Ghana and are valued for their multiple benefits (i.e. reciprocal trust and support, information sharing, motivation, risk sharing). Trusting relations with healthcare and insurance providers are, according healthcare clients, based on providers’ clear communication, attitude, devotion, encouragement and reliability of services. Active membership of the NHIS is positive associated with community trust, trust in healthcare providers and trust in the NHIS (p-values are .009, .000 and .000 respectively).ConclusionSocial capital can motivate clients to enroll in health insurance. Fostering social capital through improving information provision to communities and engaging community groups in health care and NHIS services can facilitate peoples’ trust in these institutions and their active participation in the scheme.

Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana.

In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP. Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome. Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level. Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels by ensuring constant availability of essential drugs, doctors, and shorter waiting time. However, individual enrolees may value each criterion differently. Thus, not all enrolees may be motivated by same concerns. This requires providers to be circumspect regarding the factors that may attract enrolees. The National Health Insurance Authority (NHIA) should also ensure timely release of funds to help providers procure the necessary medical supplies to ensure quality service.

An Assessment of the National Health Insurance Scheme in the Sekyere South District, Ghana

As part of government’s pro-poor strategy to increase access to and improve the quality of basic healthcare services, the National Health Insurance Act (National Health Insurance Authority, 2003, 2010 and 2013) was passed in 2003. The study assessed 379 heads of household, 5 heads of health facilities and the scheme managements’ perception on quality of health service delivery, implementation of the capitation programme, operation of the National Health Insurance Scheme (NHIS) and performance of scheme operators and service providers in the Sekyere South District of Ghana. Findings indicate that 73.9% of the heads of household had registered for NHIS and out of this figure 74.5% had renewed their cards. Despite a high renewal level, 30.3% are not satisfied with the services provided. With the introduction of the capitation grant, 25% of private service providers have withdrawn their services due to inadequate per capita payment on the scheme and 17.3% of the heads of household had difficulty in tracing their names at their preferred choice of health facility which have the tendency of affecting the sustainability of the NHIS. The study therefore recommends that, the National Health Insurance Authority should ensure upward adjustment of the monthly per capita payment made to service providers to reflect reality and also intensify education on the capitation policy for both service providers and the scheme beneficiaries.