scholarly journals What alternative and innovative domestic methods of healthcare financing can be explored to fix the current claims reimbursement challenges by the National Health Insurance Scheme of Ghana? Perspectives of health managers

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Alexander Suuk Laar ◽  
Michael Asare ◽  
Philip Ayizem Dalinjong
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Healthcare Services ◽  
Health Facilities ◽  
Healthcare Financing ◽  
Insurance Scheme ◽  
Local Methods ◽  
Health Managers

Abstract Background Low-and-middle -income countries (LMICs), to achieve sustainable universal health coverage (UHC) governments are implementing local and sustainable methods of healthcare financing. However, in Ghana, there is limited evidence on these local methods for healthcare financing to inform policy. This study aimed at exploring health managers views on alternative domestic and sustainable methods of healthcare financing for UHC under the National Health Insurance Scheme (NHIS). Methods A qualitative study using in-depth interviews with 16 health facility managers were held. The health facilities and participants were selected using convenience and purposive sampling methods. A written consent was obtained from participants prior to participation in the interview. Data was transcribed verbatim and analyzed using thematic framework approach. Results Health managers across all the health facilities mentioned delayed and erratic claims reimbursement to health facilities as the main challenge. Participants attributed the main reason to lack of funds by the National Health Insurance Authority (NHIA). They said the delayed and irregular payments has been a challenge to efficient delivery of quality healthcare to clients. That in some instances they have been compelled to demand cash or out-of-pocket payment from insured clients or insurance card bearers to be able to render needed healthcare services to them. Participants think that to ensure regular reimbursement of claims to the health facilities by the NHIA, the managers think alternative local sources of funding need to be explored to fill the funding gap. To put in place this, they suggested the need to start levying special taxes on natural resources such as crude oil and gas, gold, bauxite, cocoa, mobile money transfers, airtime and increasing the proportion of levies on the existing Value Added Tax (VAT). Conclusion The study provides important insights into potential innovative alternative domestic sources for raising additional funds to finance healthcare services in Ghana. Despite the potential of these sources, it is important for governments and health policy makers in Ghana and other LMICs who are working towards implementing innovative local methods using special levies on mobile communication services and natural resources to finance their UHC, to implement those that best suit their economies to ensure equity for better health.

scholarly journals What Alternative and Innovative Sources of Healthcare Finance Can be Explored for the Sustainability of the National Health Insurance Scheme of Ghana? Perspectives of Health Managers

2020 ◽  
Author(s):  
Alexander Suuk Laar ◽  
Michael Asare ◽  
Philip Ayizem Dalinjong
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Health Insurance Scheme ◽  
Telecommunication Service ◽  
Healthcare Financing ◽  
Insurance Scheme ◽  
Main Challenge ◽  
Health Managers

Abstract BackgroundSustainable healthcare financing is one of the key components for the achievement of universal health coverage (UHC) globally. This study explored health managers views on alternative and sustainable healthcare financing sources for the National Health Insurance Scheme (NHIS) in Ghana. MethodsA qualitative study using in-depth interviews with 16 health facility managers were held. The participants were selected using purposive sampling. A written consent was obtained from participants prior to participation in the interview. Data was transcribed verbatim and analyzed using thematic framework approach. Results All the participants indicated reimbursement of claims to health facilities by the NHIS as the main challenge. They attributed reasons to inadequate provision of funds from Government and the National Health Insurance Authority. Concerns were raised about how the situation affected health managers’ delivery of services to insured clients. Participants suggested exploring of additional funding sources by levying of special taxes on incomes from local natural resources and telecommunication service companies in Ghana to raise additional funds. Conclusion The findings of this study are important to government of Ghana and similar settings in LMICs who are working towards sustainable financing of their UHC system.

scholarly journals What Alternative and Innovative Sources of Healthcare Finance Can Be Explored for the Sustainability of the National Health Insurance Scheme of Ghana? Perspectives of Health Managers

2020 ◽  
Author(s):  
Alexander Suuk Laar ◽  
Michael Asare ◽  
Philip Ayizem Dalinjong
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Health Insurance Scheme ◽  
Telecommunication Service ◽  
Healthcare Financing ◽  
Insurance Scheme ◽  
Main Challenge ◽  
Health Managers

Abstract Background Sustainable healthcare financing is one of the key components for the achievement of universal health coverage (UHC) globally. This study explored health managers views on alternative and sustainable healthcare financing sources for the National Health Insurance Scheme (NHIS) in Ghana. Methods A qualitative study using in-depth interviews with 16 health facility managers were held. The participants were selected using purposive sampling. A written consent was obtained from participants prior to participation in the interview. Data was transcribed verbatim and analyzed using thematic framework approach. Results All the participants indicated reimbursement of claims to health facilities by the NHIS as the main challenge. They attributed reasons to inadequate provision of funds from Government and the National Health Insurance Authority. Concerns were raised about how the situation affected health managers’ delivery of services to insured clients. Participants suggested exploring of additional funding sources by levying of special taxes on incomes from local natural resources and telecommunication service companies in Ghana to raise additional funds. Conclusion The findings of this study are important to government of Ghana and similar settings in LMICs who are working towards sustainable financing of their UHC system.

scholarly journals The bypassing of healthcare facilities among National Health Insurance Scheme enrollees in Ibadan, Nigeria

2020 ◽  
Author(s):  
Adetola O Oladimeji ◽  
David A Adewole ◽  
Folashayo Adeniji
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Health Facilities ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional Survey ◽  
Additional Time ◽  
Cross Sectional

Abstract Background Bypassing occurs when patients knowingly visit a health facility other than the one they live nearest to. In Ibadan, southwest Nigeria, the majority of enrollees in the National Health Insurance Scheme (NHIS) receive medical care in just 12% of the available NHIS-accredited facilities. Given that enrollees access healthcare services at highly subsidized rates under the scheme, this study aimed to determine the factors responsible for the observed distribution of enrollees across these health facilities. Methods The study was a descriptive cross-sectional survey conducted among NHIS enrollees receiving care at outpatient departments of five randomly selected accredited health facilities in Ibadan. A total of 311 NHIS enrollees were consecutively recruited and a semistructured, pretested, interviewer-administered questionnaire was used to elicit information from respondents. Descriptive and inferential statistics were used to present results at 5% level of significance. Distance traveled by patients from their residence to the facilities was measured using Google maps. Results The mean age of respondents was 37.1±16.1 y. There were 167 (53.7%) males and 224 (72.3%) were married. The bypassing rate was 174 (55.3%). More than a third of enrollees, 127 (41.0%), reported that their hospital choice was made based on physician referral, 130 (41.8%) based on personal choice, 26 (8.4%) based upon the recommendation of the Health Management Organization (HMO), while 27 (8.7%) were influenced by friends/family/colleagues. Bypassing was positively associated with educational status (X2 = 13.147, p=0.004). Respondents who bypassed expended additional time and money traveling to the farther away hospitals, 35.1 (±34.66) min and 389.51 (±545.21) naira per visit, respectively. Conclusion The level of bypassing among enrollees was fairly high. Enrollees should be properly guided regarding the need to access healthcare in facilities closer to them by their HMOs and physicians in the case of referrals. This will reduce bypassing and the cost of travel leading to better outcomes among enrollees.

scholarly journals Access to health in city slum dwellers: The case of Sodom and Gomorrah in Accra, Ghana

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Frances E. Owusu-Ansah ◽  
Harry Tagbor ◽  
Mabel Afi Togbe
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Health Facilities ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Slum Dwellers ◽  
Access To Health

Background: Rapid rural-urban migration of people to cities is a reality around the globe that has increased city slum dwellers. Sodom and Gomorrah is a city slum located in the heart of Accra, Ghana. Like other slums, it lacks basic amenities necessary for dwellers’ quality of life. This study describes residents’ access to health and factors associated with the use of healthcarefacilities.Methods: Questionnaires were administered in systematically selected shacks across the entire slum. Data on demographic characteristics, existent health facilities and number of users, health-insured residents and knowledge of common diseases were collected.Results: Majority of the residents were from the northern parts of Ghana, relative to the south and a few of them come from other parts of West Africa. Seventy-one percent of residents had never visited a health facility in the last 5 years. When necessary, they access health care from drug stores (61.1%) or hospitals (33.1%). Residents’ age, educational status, income, health knowledge and membership of National Health Insurance Scheme were significantly (p < 0.05) associated with the use of healthcare facilities. Younger residents and those without National Health Insurance Scheme membership, formal education, no knowledge of common illnesses and regular income were significantly less likely to use a healthcare facility. For most residents, neither distance (73.2%) nor transportation to health facilities was a problem (74.1%).Conclusion: Conditions of profound environmental hazards, overcrowding, poor-quality housing and lack of health care in Sodom and Gomorrah pose grave threats to the health of the inhabitants. Multisectoral interventions and resource mobilisation championed by the Ministry of Local Government and Rural Development are needed to alter the trend.Keywords: Slum dwellers, health, access, Sodom and Gomorra, Ghana

scholarly journals Awareness, Knowledge and Perception of The National Health Insurance Scheme (NHIS) Among Health Professionals in Mthatha General Hospital, Eastern Cape, South Africa

2017 ◽  
Vol 10 (1) ◽  
pp. 187-194 ◽  
Author(s):  
Olawumi Oladimeji ◽  
Adeyinka Alabi ◽  
Oladele Vincent Adeniyi
Keyword(s):  
Health Insurance ◽  
General Hospital ◽  
National Health Insurance ◽  
National Health ◽  
Health Professionals ◽  
National Health Insurance Scheme ◽  
Health Facilities ◽  
Health Insurance Scheme ◽  
Eastern Cape ◽  
Insurance Scheme

Objective:This Eastern Cape study assessed the awareness, knowledge and perceptions of the healthcare professionals in Mthatha General Hospital on National Health Insurance Scheme (NHIS).Method:A descriptive cross-sectional study was conducted among health professionals at Mthatha General Hospital. A simple random sample of 100 participants drawn across the various categories of health professionals responded to a validated questionnaire on awareness, purpose and challenges of implementation of NHIS.Results:Of the total (N=100), 86 health professionals returned the questionnaire (response rate=87%); 54 female (63%) and 32 male (37%). The majority of the respondents were nurses (67%) and doctors (28%). Others were radiographers (n=2) and clinical associates (2). The majority of the respondents (89.5%) were aware of NHIS and their sources of information on NHIS were: seminars and meetings (n=32), television and radio (n=26), friends and family members (n=14), newspapers (n=10) and internet (n=4). Good understanding of the objectives of NHIS was demonstrated by 81.3% (n=70) of the respondents. The poor state of health facilities and inadequate staffing across the country were reported as the major impediments to the implementation of NHIS. However, the majority of the respondents (n=64) expected that the quality of healthcare service delivery would improve by increasing the staff strength in the various health facilities.Conclusion:The majority of the health professionals in this setting were aware of NHIS. Both the infrastructure and staff strength require the attention of the health authorities in order to effectively implement the scheme in the district.

scholarly journals How does it affect service delivery under the National Health Insurance Scheme in Ghana? Health providers and insurance managers perspective on submission and reimbursement of claims

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247397
Author(s):  
Patricia Akweongo ◽  
Samuel Tamti Chatio ◽  
Richmond Owusu ◽  
Paola Salari ◽  
Fabrizio Tedisio ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
Service Delivery ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Health Service Delivery ◽  
Health Facilities ◽  
Health Insurance Scheme ◽  
Insurance Scheme

Introduction In 2003, the Government of Ghana launched the National Health Insurance Scheme (NHIS) to enable all Ghanaian residents to have access to health services at the point of care without financial difficulty. However, the system has faced a number of challenges relating to delays in submission and reimbursement of claims. This study assessed views of stakeholders on claims submission, processing and re-imbursement under the NHIS and how that affected health service delivery in Ghana. Methods The study employed qualitative methods where in-depth interviews were conducted with stakeholders in three administrative regions in Ghana. Purposive sampling method was used to select health facilities and study participants for the interviews. QSR Nvivo 12 software was used to code the data into themes for thematic analysis. Results The results point to key barriers such as lack of qualified staff to process claims, unclear vetting procedure and the failure of National Health Insurance Scheme officers to draw the attention of health facility staff to resolve discrepancies on time. Participants perceived that lack of clarity, inaccurate data and the use of non-professional staff for NHIS claims vetting prolonged reimbursement of claims. This affected operations of credentialed health facilities including the provision of health services. It is perceived that unavailability of funds led to re-use of disposable medical supplies in health service delivery in credentialed health facilities. Stakeholders suggested that submission of genuine claims by health providers and regular monitoring of health facilities reduces errors on claims reports and delays in reimbursement of claims. Conclusion Long delays in claims reimbursement, perceived vetting discrepancies affect health service delivery. Thus, effective collaboration of all stakeholders is necessary in order to develop a long-term strategy to address the issue under the NHIS to improve health service delivery.

scholarly journals Out-of-Pocket Payments for Health Care Under the National Health Insurance Scheme in Ghana: What Do Insured Clients Pay for?

2021 ◽  
Author(s):  
Patricia Akweongo ◽  
Moses Aikins ◽  
Kaspar Wyss ◽  
Paola Salari ◽  
Fabrizio Tediosi
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Facility ◽  
National Health Insurance ◽  
National Health ◽  
National Health Insurance Scheme ◽  
Health Facilities ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Out Of Pocket Payments

Abstract Background In 2003, Ghana implemented a national health insurance scheme (NHIS) designed to promote universal health coverage and equitable access to health care. The scheme has largely been successful, yet it is confronted with many challenges threatening its sustainability. Out-of-pocket payments (OOP) by insured clients is one such challenges of the scheme. This study sought to examine the types of services OOP charges are made for, who pays these charges and how much clients pay out-of-pocket.Methods This was a descriptive cross-sectional health facility survey. A total of 2066 respondents were interviewed using structured questionnaires at the point of health care exit in the Ashanti, Northern and Central regions of Ghana. Health facilities of different levels were selected from 3 districts in each of the three regions. Data were collected between April and June 2018. Using Epidata and STATA Version 13.1 data analyses were done using multiple logistic regression and simple descriptive statistics and results presented as proportions and means.Results Of all survey respondents 49.7% reported paying out-of-pocket for out-patient health care while 48.6% of insured clients paid out-of-pocket. 42% of the insured poorest quintile also paid out-of-pocket. Respondents suffered fever-malaria like symptoms (45.7%). Insured clients paid for consultation (75%) and drugs (68.5%) and 34.9% purchased drugs outside the health facility visited. The unavailability of the drugs (67.9%) and drugs not covered by the NHIS (20.8%) led to out-of-pocket payments. On average patients paid GHS33.00 (USD6.6) out-of-pocket. Compared to the Northern region, patients living in the Ashanti region were 4.4 times more at odds to pay out-of-pocket for health care. Conclusions and recommendations Insured clients of Ghana’s NHIS seeking health care in accredited health facilities make out-of-pocket payments for consultation and drugs that are covered by the scheme. The out-of-pocket payments are largely attributed to unavailability of drugs at the facilities and occur in disadvantaged regions and in all health facilities. Out-of-pocket payments under NHIS implications for unequal access to insured services.

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