Background
Ghana’s National Health Insurance Scheme is a demand side programme where the governing authority registers clients and purchases health care services for them from public and private providers. Access of services is high across a broad Benefits Package with no parallel enrolment necessary for any type of service at the point of access. Nonetheless, there is evidence of difficulty in acquiring and use of the NHIS card to access health care services.
Objective
While studies had been conducted into general awareness, there was no linkage between awareness, uptake and experiences with registration and use of the card. This study fills this gap.
Methods
This is a descriptive study. A mix of qualitative (39 Focus Group Discussions) and quantitative (625 household interviews) methods were used to collect the data. Qualitative data was analysed manually using a thematic approach while a frequency analysis was done for the quantitative data.
Results
Knowledge about the Scheme was near universal. Enrolment was lower among FGD discussants, 38.7% had valid cards, than for household respondents, 62.9% valid cards. While mixed experiences with the registration process was observed among FGD discussants, 74% of the households’ ranked attitudes of Scheme staff as positive. The study found the NHIS card facilitates access to facility based health care. Satisfaction levels with use of the card were mixed and contextual among discussants. However, 90% of households reported their cards were readily accepted at health facilities. Expired card (51.4%) and health facility had stopped accepting NHIS cards (14.3%) were mentioned as reasons for non-acceptance.
Conclusion
People’s experience during registration and use of the NHIS card to access health care has lasting effect on their perceptions of the Scheme. This can be harnessed to manage the high expectations, grow membership, discourage frivolous use and address artificial barriers of access.
Perceptions of and support for national health insurance in South Africa�s public and private healthcare sectors
