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Kipo-Sunyehzi, Amogre Ayanore, Dzidzonu, and Ayalsuma Yakubu. "Ghana’s Journey towards Universal Health Coverage: The Role of the National Health Insurance Scheme." European Journal of Investigation in Health, Psychology and Education 10, no. 1 (October 1, 2019): 94–109. http://dx.doi.org/10.3390/ejihpe10010009.
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: Background: the main aim of the study is to find if the National Health Insurance Scheme (NHIS) in Ghana is achieving universal health coverage (UHC) or not. The study gives the trajectories of health policies in Ghana and their implications on long term health financing. NHIS in Ghana was implemented in 2004, with the aim of increasing subscribers’ access to health care services and reduce financial barriers to health care. On equity access to healthcare, it addresses two core concerns: (1) enrolling particular groups (persons exempted from annual premium payments) and (2) achieving UHC for all citizens and persons with legal residence. It utilizes a multifactor approach to the conceptualization of UHC. The research question: is Ghana’s NHIS on course to deliver or achieve universal health coverage? Methods: we used qualitative methods. In doing so, the study engaged participants in in-depth interviews, focus group discussions and direct observations of participants in their natural settings, like hospitals, clinics, offices and homes, with purposive and snowball techniques. This data triangulation approach aims to increase the reliability and validity of findings. Results: the empirical evidence shows NHIS performed relatively well in enrolling more exempt groups (particular groups) than enrolling all persons in Ghana (UHC). The biggest challenge for the implementation of NHIS from the perspectives of health insurance officials is inadequate funding. The health insurance beneficiaries complained of delays during registrations and renewals. They also complained of poor attitude of some health insurance officials and health workers at facilities. Conclusions: both health insurance officials and beneficiaries emphasized the need for increased public education and for implementers to adopt a friendly attitude towards clients. To move towards achieving UHC, there is a need to redesign the policy, to move it from current voluntary contributions, to adopt a broad tax-based approach to cover all citizens and persons with legal residence in Ghana. Also, to adopt a flexible premium payment system (specifically ‘payments by installation’ or ‘part payments’) and widen the scope of exempt groups as a way of enrolling more into the NHIS.
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Kodom, Michael, Adobea Yaa Owusu, and Perpetual Nancy Baidoo Kodom. "Quality Healthcare Service Assessment under Ghana’s National Health Insurance Scheme." Journal of Asian and African Studies 54, no. 4 (February 26, 2019): 569–87. http://dx.doi.org/10.1177/0021909619827331.
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Ghana implemented the National Health Insurance Scheme (NHIS) in 2005 with the intention of providing residents with quality affordable healthcare. Over the past few years, concerns have been raised about the quality of healthcare clients receive. This study assesses the experiences of NHIS subscribers with the quality of care they receive under the scheme by both private and public hospitals. The results from the 56 interviews show that the majority of the subscribers were dissatisfied with the overall quality of healthcare they received in both private and public hospital because of the long waiting hours, the poor attitude of nurses and the demand for payment of additional money. Even though clients who visited the private hospital paid for all services, excluding consultation, their level of satisfaction with the quality of healthcare was relatively higher than those who visited the public hospital. The paper concludes that NHIS clients do not receive the quality of healthcare the scheme promised, and this has implications for premium renewals and health-seeking behaviour.
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Aboagye, Da Costa, Jane South, and Hafiz T. A. Khan. "Evaluation of Community Perspectives on National Health Insurance Policy to Health Service Delivery in Ghana." Illness, Crisis & Loss 29, no. 1 (February 12, 2018): 3–18. http://dx.doi.org/10.1177/1054137318756270.
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This article aims to examine the National Health Insurance Scheme (NHIS) policy from the perspective of local communities. Qualitative data from 9 key informant interviews and 72 community respondents in 9 focus group discussions were analyzed using a thematic network approach. The focus-group discussions took place in seven different communities in seven regions of Ghana. The findings noted a disconnection between NHIS policy and community life. More so, the findings showed an explicit link between equity and access with its impacts on health outcomes. The qualitative results indicated lack of voice and understanding as the features limiting people from accessing the NHIS facilities. Understanding of equity as a key theme revealed, first, lack of stakeholder engagement and consultation or participation in the NHIS decision-making process. Second, it was established that while the policy indicated a will to include all the core poor for an equitable NHIS, there is lack of willingness to implement this aim fully. Finally, despite being a pro-poor intervention by name, practical management of the NHIS is transmitted down vertical silos from the national level, with the lack of joined-up government at the center undermining local partnerships. Thus, not only are national expectations being dashed locally, local expectations are dashed nationally. This article proposes that community viewpoints should be given higher priority given that NHIS has since its inception been associated with medical treatments and biomedical paradigm. Promoting community participation, understanding, and voices should be recognized to shape the future NHIS policy and practice.
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Marvel, Ehiosun O. "An Appraisal of Clients’ Utilization of National Health Insurance Scheme (NHIS) Services at the Kubwa General Hospital." International Letters of Social and Humanistic Sciences 84 (October 2018): 35–46. http://dx.doi.org/10.18052/www.scipress.com/ilshs.84.35.
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NHIS was launched officially on 6th of June 2005. The Scheme is designed to provide comprehensive health care at affordable costs, covering employees of the formal sector, self-employed, as well as rural communities, the poor and the vulnerable groups. However, client satisfaction of services rendered continues to be a major concern for the improvement of NHIS. This study is designed to determine the level and causes of dissatisfaction of clients accessing NHIS clinic at the Kubwa General Hospital, Kubwa, FCT, Abuja. This study employed a descriptive cross sectional survey. 279 NHIS enrollees were recruited for this study at the Kubwa General Hospital. Questionnaires were administered and the level of dissatisfaction and satisfaction of NHIS services were analyzed. The satisfaction rate was 69.2% while the dissatisfaction rate was 22.9%. The respondents were satisfied with the attitude of health workers in NHIS clinic, Kubwa. However, they were dissatisfied with waiting time, attitude of record officers and those in pharmacy department. This study found that the level of dissatisfaction with NHIS services is high despite a high satisfaction level. The Attitude of health workers may influence the dissatisfaction of enrollees. NHIS is still limited to the formal sector.
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Angioha, Pius U., Thomas A. Omang, Uduakobong P. Akpabio, James A. Ogar, Tersoo Asongo, and Francis Ibioro. "Improving Access to Maternal Healthcare Among Female Employees: Quantitative Analysis of the impact of The National Health Insurance Scheme." SAINSMAT: Journal of Applied Sciences, Mathematics, and Its Education 10, no. 1 (March 31, 2021): 35–42. http://dx.doi.org/10.35877/sainsmat1012112021.
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This study examines the correlation between the national health insurance scheme and access to national health care among female employees in Federal Institutions in Calabar cross river state, Nigeria. The study specifically examines the extent to which the national health insurance scheme reduces the cost of health and Enrollment in the NHIS relates to access to maternal healthcare. Two hypotheses were raised for the study. The survey research design was adopted in collecting data from 400 samples from a population of 9201 female employees of the federal institutions in Calabar cross river state. The instrument of data collection was the questionnaire. Data collected was analyzed using descriptive and correlation analysis. Results revealed that the national health insurance scheme reduced health cost relates to access to maternal healthcare. Results also indicated that Enrollment in NHIS significantly relates to access to maternal health. Based on this result, the study recommends, amongst others, that there is a need for government to improve on health funding as this will help improve access to various provisions of the scheme as it relates to maternal health
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Haw, Nel Jason L. "Utilization of the Ghana National Health Insurance Scheme and its association with patient perceptions on healthcare quality." International Journal for Quality in Health Care 31, no. 6 (August 25, 2018): 485–91. http://dx.doi.org/10.1093/intqhc/mzy185.
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Abstract Objective To determine the association between the utilization of the Ghana National Health Insurance Scheme (NHIS) and patient perceptions of quality of care. Methods Ghana Demographic and Health Survey (GDHS) 2014 had 19 questions on perceptions of quality of care received during the last reported health visit (n = 4332). These questions were summarized into an overall 100-point perception score using item response theory (IRT). Patients were divided into three utilization categories: those paying with their NHIS card fully, those paying with their card and out-of-pocket (OOP), and those paying fully OOP. A multiple linear regression model was used to measure the association between NHIS utilization and overall perception. Results In general, NHIS utilization was negatively associated with overall perception, and the difference across utilization categories was higher among private facility users than public facility users. Among private facilities, those who paid fully with NHIS reported five points lower than those who paid fully OOP (P = 0.005). Among public facilities, the difference is only 1.7 (P = 0.4342). Conclusion NHIS utilization was a negative predictor for patient perceptions, but the differences are more nuanced according to type of facility. Future GDHS rounds should continue measuring perceptions in aid of policy to improve service delivery under the NHIS.
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Aikins, Moses, Philip Teg-Nefaah Tabong, Paola Salari, Fabrizio Tediosi, Francis M. Asenso-Boadi, and Patricia Akweongo. "Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders." PLOS ONE 16, no. 6 (June 15, 2021): e0253109. http://dx.doi.org/10.1371/journal.pone.0253109.
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Introduction The National Health Insurance Scheme (NHIS) was introduced in 2003 to reduce “out-of-pocket” payments for health care in Ghana. Over a decade of its implementation, issues about the financial sustainability of this pro-poor policy remains a crippling fact despite its critical role to go towards Universal Health Coverage. We therefore conducted this study to elicit stakeholders’ views on ways to improve the financial sustainability of the operations of NHIS. Methods Twenty (20) stakeholders were identified from Ministry of Health, Ghana Health Services, health workers groups, private medical practitioners, civil society organizations and developmental partners. They were interviewed using an interview guide developed from a NHIS policy review and analysis. All interviews were recorded and transcribed verbatim. The data were analysed thematically with the aid of NVivo 12 software. Results Stakeholders admitted that the NHIS is currently unable to meet its financial obligations. The stakeholders suggested first the adoption of capitation as a provider payment mechanism to minimize the risk of providers’ fraud and protection from political interference. Secondly, they indicated that rapid releases of specific statutory deductions and taxes for NHIS providers could reduce delays in claims’ reimbursement which is one of the main challenges faced by healthcare providers. Aligning the NHIS with the Community-based Health Planning and Services and including preventive and promotive health is necessary to position the Scheme for Universal Health Coverage. Conclusion The Scheme will potentially achieve UHC if protected from political interference to improve the governance and transparency that affects the finances of the scheme and the expansion of services to include preventive and promotive services and cancers.
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Amos Paul Bassi, Ebenezer Chinomnso Anthony, Bukunmi Tejumade Adediran, Jemima Abner, Solomon Mallum Anyakwai Thliza, and Chris Anyanechi. "Knowledge, attitude and practice of adults to the national health insurance scheme (NHIS) in Unguwar Soya, Kabong Ward of Jos North LGA, Plateau State-Nigeria." GSC Biological and Pharmaceutical Sciences 16, no. 1 (July 30, 2021): 239–50. http://dx.doi.org/10.30574/gscbps.2021.16.1.0209.
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Health, according to the World Health Organization is defined as a state of complete physical, mental, social and spiritual wellbeing, and not merely the absence of disease or infirmity. This was a cross sectional community based descriptive study using a multi stage sampling technique in Unguwar Soya Community, Kabong, Jos North LGA, Plateau State, Nigeria with the aim of assessing and establishing the knowledge, attitude and practice of the residents to NHIS. An interviewer administered structured questionnaire was utilized and a total of 252 questionnaires were administered to the eligible members of the community. Majority of the Respondents are aged 20-29 years (33.7%). Majority of the respondents were females (63.5%), largely married (54.0%), most have attended secondary level of education (47.2%) and are mostly Artisans (32.1%) with majority earning above 30,000 naira (25.8%).59.5% of the respondents had heard about NHIIS; family and friends were the most common sources of NHIS awareness (25.5%). Majority of the respondents (49.3%) had heard about NHIS more than five years ago. Majority of the respondents (70.7%) had good attitude towards NHIS. Only 13.3% of the respondents are registered with NHIS. 88.5% of the respondents fund their health expenditures through Out-of-pocket payment. Results depicted that the index population has inadequate awareness and knowledge of the National Health Insurance Scheme. Resulting in the small portion of the population participating in the scheme. The government can come to the aid of this community and other communities by providing adequate awareness, knowledge and privilege to participate in the scheme to better their health.
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Emmanuel, Amangbey, Gandiibu A. Julius, and Gbaran Gbolo. "Sustaining the National Health Insurance Scheme in Ghana: Perceptions and Experiences of Health Care Providers and Subscribers." International Journal of Social Science Research 6, no. 1 (December 29, 2017): 29. http://dx.doi.org/10.5296/ijssr.v6i1.11633.
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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.
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Thapa, Sailendra, Puspa Acharya, and Durga Khadka Mishra. "Perception towards national health insurance scheme among enrollees of central Terai: a qualitative study." International Journal of Scientific Reports 7, no. 2 (January 22, 2021): 80. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20210090.
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<p class="abstract"><strong>Background:</strong> Out of Pocket Expenditure has always been a primary means of financing health care service in Nepal. National Health Insurance Scheme ensures universal health coverage by addressing the unregulated out-of-pocket spending and providing quality of health service.</p><p class="abstract"><strong>Methods:</strong> A descriptive cross-sectional study was conducted among the enrollees of the National Health Insurance Scheme (NHIS) in Bharatpur Metropolitan City of Chitwan district. Focused Group Discussions were conducted among enrollees to assess the perception towards National Health Insurance Scheme. The qualitative data were analyzed as thematic analysis technique. </p><p class="abstract"><strong>Results:</strong> Perception towards National Health Insurance Scheme was categorized as perceived quality of care, perceived benefit and provider’s behavior. Respondents were fully satisfied with the premium charge. Availability of drugs was improved but the waiting time and the process of registration was lengthy and full of jargons. Most of the participants perceived that due to less number of service providers or due to inability of allocating separate provider for ensured persons, the consultation time was very less which further affects the quality of care. Enrollment Assistants were considered as primary source of information regarding the NHIS.</p><p class="abstract"><strong>Conclusions:</strong> Long waiting time, difficulty during registration and less number of service providers remain challenge to receive quality of care under NHIS. Participants perceived that the benefit package under affordable premium charge is in favor of them. Addressing these factors in expansion of this program in other district might leads for success of this scheme.</p><p align="center"> </p>
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Adhikari, Anju, Nand Ram Gahatraj, and Dipendra Kumar Yadav. "Factors Associated with Non-Enrollment in National Health Insurance Scheme in Kaski District, Nepal." Nepalese Journal of Insurance and Social Security 3, no. 3 (December 1, 2020): 77–90. http://dx.doi.org/10.3126/njiss.v3i3.36464.
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Health insurance poses a vital role in developing countries, to attain an equitable health outcome to all citizens by ensuring universal health coverage. This study aims to assess the factors associated with non-enrollment in National Health Insurance Scheme (NHIS) in a setting of Nepal. A cross-sectional study was conducted among 492 households (246 non-enrolled and 246 enrolled) of Kaski district, Nepal from May to August 2020. Data were gathered from face-to-face interview. Data were entered in Epi data 3.1 and analysed by using statistical package for social sciences (SPSS16). Descriptive and inferential statistics were performed to analyze the data. The household without elderly family members were 2.06 times less likely to enroll in the scheme (AOR=2.060, CI=1.141-3.721, p<0.01). Similarly, non-enrollment increases with the decreasing wealth quintile of the family (AOR=4.312, CI=1.881-9.880, p<0.001). Families who perceived their family health status as fair was more likely to join the scheme than those as a good health status. Households who had poor or average knowledge on the scheme were almost five times more likely to non-enrollment (AOR=4.641, CI=2.841-7.582, p <0.001). Factors that determine the non-enrolment in NHIS are households had without elderly family members, poor wealth quintile, self-perceived good health status and poor knowledge on NHIS. Effective coordination from different stakeholders need to increase the health insurance coverage and increase the health literacy through the wide coverage of health communication program.
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Adebiyi, Obelebra, and Foluke Olukemi Adeniji. "Factors Affecting Utilization of the National Health Insurance Scheme by Federal Civil Servants in Rivers State, Nigeria." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 58 (January 2021): 004695802110176. http://dx.doi.org/10.1177/00469580211017626.
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The National Health Insurance Scheme (NHIS) of Nigeria was established in 2005. This study assessed the utilization of health care and associated factors amongst the federal civil servants using the NHIS in Rivers state. This was a descriptive cross-sectional study using self-administered questionnaires. Data were collated and analyzed using SPSS version 21.0. A Chi-square test was carried out. The level of Confidence was set at 95%, and the P-value ≤ .05. Out of a total of 334 respondents, 280 (83.8%) were enrolled for NHIS, 203 (72.5%) utilized the services of the scheme. Most 181 (82.1%) of the respondents who utilized visited the facility at least once in the preceding year. Although, 123 (43.9%) of the respondents made payments at a point of access to health care services, overall there was a reduction in out of pocket payment. Possession of NHIS card, the attitude of health workers, and patients’ satisfaction were found to significantly affect utilization P ≤ .05. Regression analysis shows age and income to be a predictor of utilization of the NHIS. Though utilization is high, effort should be made to remove payment at the point of access and improving the harsh attitude of some of the health workers.
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van der Wielen, Nele, Andrew Amos Channon, and Jane Falkingham. "Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana." BMJ Global Health 3, no. 1 (February 2018): e000590. http://dx.doi.org/10.1136/bmjgh-2017-000590.
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IntroductionThis paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed.MethodsUsing the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over.ResultsThe raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled.ConclusionThe results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.
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Baozhen, Dai, Minkah Andrews Yaw, Osei-Assibey Mandella Bonsu, and Agyemang Fredua Sylvester Prempeh. "Assessing Factors Affecting the Patronage of Health Insurance Schemes: An Evidence of Ghana." Journal of Public Administration and Governance 9, no. 1 (March 1, 2019): 73. http://dx.doi.org/10.5296/jpag.v9i1.14442.
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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.
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Unachukwu, Jemeni Chukwudi, Dr Ademola Samuel Sajuyigbe, and Itunu I. Odebiyi. "Adoption of the National Health Insurance Scheme and Its Influence on Organizational Commitment." Business Perspective Review 2, no. 3 (October 6, 2020): 1–10. http://dx.doi.org/10.38157/business-perspective-review.v2i3.171.
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Purpose: The study examines the influence of the adoption of the National Health Insurance Scheme on organizational commitment with particular reference to Kwara State, Nigeria.
Method: A cross-sectional descriptive study was adopted for the study. A purposive sampling technique was employed to select 350 civil servants from the Ministry of Health in Ilorin. Data were analyzed with the assistance of mean and ordinary least square method of estimation.
Result: The results reveal that the adoption of the National Health Insurance Scheme (NHIS) has a significant influence on organizational commitment. This indicates that the “modus operandi” of the scheme is a strong predictor of organizational commitment in Nigeria.
Implication: Deduction to be made from this result is that the “modus operandi” of the scheme is a strong predictor of organizational commitment. This indicates that the sustainability of the NHIS is a guarantee in the country. This will pave the way to achieve Sustainable Development Goals (SDGs) of ‘universal health coverage, such as financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all by 2030.
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Kwadwo, Adusei-Asante. "Impact of the National Health Insurance Scheme on Drugstores and Traditional Medicines in Ghana." Journal of Business and Economics 9, no. 5 (May 20, 2018): 375–87. http://dx.doi.org/10.15341/jbe(2155-7950)/05.09.2018/001.
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Ghana established a pro-poor hospital-based National Health Insurance Scheme (NHIS) in 2004. Since the introduction of the scheme, limited research has been undertaken on its impact on Ghana’s healthcare options, which consist of traditional medicines, commercial pharmacies (drugstores) and faith healing. This paper draws on an ethnographic study conducted in the Daakye District of Ghana, and argues that although the NHIS has led to increased patronage of hospital-based treatment, the other healthcare options remain popular. Interrelated factors, including poverty, remoteness and cultural perceptions, were found to be drivers of the popularity of the non-hospital healthcare options. This paper seeks to contribute to recent discussions in the Ghanaian media on the government’s intention to integrate traditional medicines into Ghana’s healthcare delivery system.
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Salari, Paola, Patricia Akweongo, Moses Aikins, and Fabrizio Tediosi. "Determinants of health insurance enrolment in Ghana: evidence from three national household surveys." Health Policy and Planning 34, no. 8 (August 21, 2019): 582–94. http://dx.doi.org/10.1093/heapol/czz079.
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Abstract In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) to move towards Universal Health Coverage. NHIS enrolment is mandatory for all Ghanaians, but the most recent estimates show that coverage stands under 40%. The evidence on the relationship between socio-economic characteristics and NHIS enrolment is mixed, and comes mainly from studies conducted in a few areas. Therefore, in this study we investigate the socio-economic determinants of NHIS enrolment using three recent national household surveys. We used data from the Ghanaian Demographic and Health Survey conducted in 2014, the Multiple Indicator Cluster Survey conducted in 2011 and the sixth wave of the Ghana Living Standard Survey conducted in 2012–13. Given the multilevel nature of the three databases, we use multilevel logistic regression models to estimate the probability of enrolment for women and men separately. We used three levels of analysis: geographical clusters, household and individual units. We found that education, wealth, marital status—and to some extent—age were positively associated with enrolment. Furthermore, we found that enrolment was correlated with the type of occupation. The analyses of three national household surveys highlight the challenges of understanding the complex dynamics of factors contributing to low NHIS enrolment rates. The results indicate that current policies aimed at identifying and subsidizing underprivileged population groups might insufficiently encourage health insurance enrolment.
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Fiestas Navarrete, Lucia, Simone Ghislandi, David Stuckler, and Fabrizio Tediosi. "Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana." Health Policy and Planning 34, no. 9 (September 20, 2019): 694–705. http://dx.doi.org/10.1093/heapol/czz093.
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Abstract A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012–13 Ghana Living Standards Survey (n = 72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (−5 p.p. vs −9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (−10 p.p. vs. −6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC.
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Celestine E, Ekwuluo, Eluwa Achama N, Okereke Isaac C, and Orji Somtochukwu B. "KNOWLEDGE, ATTITUDES TO, AND UTILIZATION OF THE NATIONAL HEALTH INSURANCE SCHEME (NHIS) AMONG HEALTH WORKERS IN THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL(UNTH), ITUKU-OZALLA, ENUGU STATE, NIGERIA." International Journal of Research -GRANTHAALAYAH 6, no. 1 (January 31, 2018): 1–22. http://dx.doi.org/10.29121/granthaalayah.v6.i1.2018.1590.
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This is a study to determine the knowledge, attitudes to, and utilization of the National Health Insurance Scheme (NHIS) among health workers at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, and Enugu State, Nigeria. It is a descriptive study. Information was gathered using a closely monitored interviewer-administered questionnaire.
Method: A stratified random sampling method in which 328 questionnaires were satisfactory completed, was carried out in December 2011 at the University of Nigeria, Teaching Hospital, Ituku-Ozalla. The questionnaires used in this study were a combination of both structured close-ended questions and unstructured open-ended questions. The data was analyzed using statistical program for social sciences (SPSS) software. Variables explored in our study were aimed at understanding the factors affecting and recommending ways of improving the knowledge, utilization of, and attitude to the National Health Insurance Scheme (NHIS) among health workers at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, Nigeria,.
Results: 188 (57.3%) of our respondent were females, while 140 (42.7%) were males. There was a 98.2% awareness among the respondents as against 1.8% who had not heard of the scheme prior to this research. About 36.3% of respondents had heard of the scheme from colleagues, 37.3% from the radio/television, while only 3.7% had gotten their information about the NHIS from the internet. 63.4% of the respondents were registered beneficiaries of the NHIS as against 36.6% who were not registered. An encouraging 70.1% of the registered respondents had actually used the scheme before. Important to note was that 41.1% of registered married respondents had actually utilized the scheme while only 39.5% of the registered single respondents were indeed users. From the research, there is a low patronage of the scheme by doctors as only 41.1% of the doctors were registered as against 60.3% of nurses, 100% of financial officers and 84.2% of the support workers that were registered.
Conclusion: 65.7% of the respondent believed that the scheme was not expensive, while only about 16.7% of the respondents wanted the scheme discontinued. Generally there is a high awareness of the National Health Insurance Scheme. However, the utilization of, and attitudes to the National Health Insurance Scheme are not encouraging. Respondents were optimistic about the scheme as majority felt it should be improved on rather than discontinued. Providing solution to the problems and limitations highlighted in our study will go a long way in improving the health and wellbeing of the health workers and by extension, the entire populace in a country like Nigeria.
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Palermo, Tia M., Elsa Valli, Gustavo Ángeles-Tagliaferro, Marlous de Milliano, Clement Adamba, Tayllor Renee Spadafora, and Clare Barrington. "Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme." BMJ Open 9, no. 11 (November 2019): e028726. http://dx.doi.org/10.1136/bmjopen-2018-028726.
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ObjectivesThe study aimed to understand the impact of integrating a fee waiver for the National Health Insurance Scheme (NHIS) with Ghana’s Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer programme on health insurance enrolment.SettingThe study was conducted in five districts implementing Ghana’s LEAP 1000 programme in Northern and Upper East Regions.ParticipantsWomen, from LEAP households, who were pregnant or had a child under 1 year and who participated in baseline and 24-month surveys (2497) participated in the study.InterventionLEAP provides bimonthly cash payments combined with a premium waiver for enrolment in NHIS to extremely poor households with orphans and vulnerable children, elderly with no productive capacity and persons with severe disability. LEAP 1000, the focus of the current evaluation, expanded eligibility in 2015 to those households with a pregnant woman or child under the age of 12 months. Over the course of the study, households received 13 payments.Primary and secondary outcome measuresPrimary outcomes included current and ever enrolment in NHIS. Secondary outcomes include reasons for not enrolling in NHIS. We conducted a mixed-methods impact evaluation using a quasi-experimental design and estimated intent-to-treat impacts on health insurance enrolment among children and adults. Longitudinal qualitative interviews were conducted with an embedded cohort of 20 women and analysed using systematic thematic coding.ResultsCurrent enrolment increased among the treatment group from 37.4% to 46.6% (n=5523) and decreased among the comparison group from 37.3% to 33.3% (n=4804), resulting in programme impacts of 14 (95% CI 7.8 to 20.5) to 15 (95% CI 10.6 to 18.5) percentage points for current NHIS enrolment. Common reasons for not enrolling were fees and travel.ConclusionWhile impacts on NHIS enrolment were significant, gaps remain to maximise the potential of integrated programming. NHIS and LEAP could be better streamlined to ensure poor households fully benefit from both services, in a further step towards integrated social protection.Trial registration numberRIDIE-STUDY-ID-55942496d53af.
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Etiaba, Enyi, Obinna Onwujekwe, Ayako Honda, Ogochukwu Ibe, Benjamin Uzochukwu, and Kara Hanson. "Strategic purchasing for universal health coverage: examining the purchaser–provider relationship within a social health insurance scheme in Nigeria." BMJ Global Health 3, no. 5 (October 2018): e000917. http://dx.doi.org/10.1136/bmjgh-2018-000917.
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BackgroundIn an attempt to achieve universal health coverage, Nigeria introduced a number of health insurance schemes. One of them, the Formal Sector Social Health Insurance Programme (FSSHIP), was launched in 2005 to provide health cover to federal government and formal private sector employees. It operates with two levels of purchasers, the National Health Insurance Scheme (NHIS) and health maintenance organisations (HMOs). This study critically assesses purchasing arrangements between NHIS, HMOs and healthcare providers and determines how the arrangements function from a strategic purchasing perspective within the FSSHIP.MethodsA qualitative study undertaken in Enugu state, Nigeria, data were gathered through reviews of documents, 17 in-depth interviews (IDIs) with NHIS, HMOs and healthcare providers and two focus group discussions (FGDs) with FSSHIP enrolees. A strategic purchasing lens was used to guide data analysis.ResultsThe purchasing function was not being used strategically to influence provider behaviour and improve efficiency and quality in healthcare service delivery. For the purchaser–provider relationship, these actions are: accreditation of healthcare providers; monitoring of HMOs and healthcare providers and use of appropriate provider payment mechanisms for healthcare services at every level. The government lacks resources and political will to perform their stewardship role while provider dissatisfaction with payments and reimbursements adversely affected service provision to enrolled members. Underlying this inability to purchase, health services strategically is the two-tiered purchasing mechanism wherein NHIS is not adequately exercising its stewardship role to monitor and guide HMOs to fulfil their roles and responsibilities as purchasing administrators.ConclusionsPurchasing under the FSSHIP is more passive than strategic. Governance framework requires strengthening and clarity for optimal implementation so as to ensure that both levels of purchasers undertake strategic purchasing actions. Additional strengthening of NHIS is needed for it to have capacity to play its stewardship role in the FSSHIP.
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Oladimeji, Olawumi, Adeyinka Alabi, and Oladele Vincent Adeniyi. "Awareness, Knowledge and Perception of The National Health Insurance Scheme (NHIS) Among Health Professionals in Mthatha General Hospital, Eastern Cape, South Africa." Open Public Health Journal 10, no. 1 (October 24, 2017): 187–94. http://dx.doi.org/10.2174/1874944501710010187.
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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.
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Okoro, Roland Nnaemeka, Chijioke Nmeka, and Patrick O. Erah. "Antibiotics prescription pattern and determinants of utilization in the national health insurance scheme at a Tertiary Hospital in Nigeria." African Health Sciences 19, no. 3 (November 4, 2019): 2356–64. http://dx.doi.org/10.4314/ahs.v19i3.8.
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Background: Subsidizing the cost of medicines through insurance schemes increases consumption of medicines and may contribute to irrational use of antibiotics. Objectives: To describe the systemic antibiotics prescriptions patterns and analyze the determinants of their utilization in the National Health insurance Scheme (NHIS).Methods: Established WHO guideline was followed to conduct this cross-sectional retrospective study at University of Nigeria Teaching Hospital, Nigeria. Data were collected from randomly sampled prescription sheets of one year duration. Logistic regression analysis was performed to determine the predictors of antibiotics prescriptions.Results: The results are based on 802 sampled out-patients NHIS prescriptions. Average number of medicines per encounter was 4.0 ± 1.8, whereas 46.9% of antibiotics were prescribed by generic name. Penicillins (most frequently amoxicillin/clavulanate), and nitroimidazole (most frequently metronidazole) were the most commonly prescribed antibiotics with percentage share of 43.3% and 22.2%. Being <5 years old, and taking more than 4 medicines (OR 2.20, 95% CI 1.37-3.55) were the factors associated with the highest risk of antibiotics exposure.Conclusion: There were poly-pharmacy, and non-adherence to generic antibiotic prescriptions. Penicillins (amoxicillin/clavulanate) were the most commonly prescribed antibiotic class. Being < 5 years old, and taking more than 4 medicines were significant predictors of antibiotics exposure.Keywords: Antibiotics; national health insurance scheme; Nigeria; poly-pharmacy; prescription.
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Nsiah-Boateng, Eric, Jennifer Prah Ruger, and Justice Nonvignon. "Is enrolment in the national health insurance scheme in Ghana pro-poor? Evidence from the Ghana Living Standards Survey." BMJ Open 9, no. 7 (July 2019): e029419. http://dx.doi.org/10.1136/bmjopen-2019-029419.
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ObjectivesThis article examines equity in enrolment in the Ghana National Health Insurance Scheme (NHIS) to inform policy decisions on progress towards realisation of universal health coverage (UHC).DesignSecondary analysis of data from the sixth round of the Ghana Living Standards Survey (GLSS 6).SettingHousehold based.ParticipantsA total of 16 774 household heads participated in the GLSS 6 which was conducted between 18 October 2012 and 17 October 2013.AnalysisEquity in enrolment was assessed using concentration curves and bivariate and multivariate analyses to determine associated factors.Main outcome measureEquity in NHIS enrolment.ResultsSurvey 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, low to high level of education and young adults to older adults. Other factors including sex, household size, household setting and geographic region were significantly associated with enrolment.ConclusionsFrom 2012 to 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.
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Michael, Godpower Chinedu, Ibrahim Aliyu, Bukar Alhaji Grema, and Abdullahi Kabiru Suleiman. "Perception of Factors Influencing Primary Health-Care Facility Choice Among National Health Insurance Enrollees of a Northwest Nigerian Hospital." Journal of Patient Experience 6, no. 3 (July 23, 2018): 247–52. http://dx.doi.org/10.1177/2374373518790072.
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Background: The National Health Insurance Scheme (NHIS) of Nigeria was designed to eliminate known cultural, physical, and resource-related barriers to quality health-care access. Although choice of primary health-care facility (PHF) remains in the domain of the scheme enrollees, little is known about factors influencing their choice. Hence, the study of the perception of factors influencing PHF choice among NHIS enrollees of a northwest Nigerian hospital becomes imperative. Methods: This was a cross-sectional study of 284 principal enrollees randomly selected from patients attending the NHIS clinic of Aminu Kano Teaching Hospital, Kano, Nigeria, using a designed, pretested, investigator-administered questionnaire. Their sociodemographics and factors influencing their choice of the clinic were assessed. Results: Respondents’ mean age was 40.9 ± 9.0 years and they were predominantly males (83.1%) with tertiary education. Median distance between their homes and PHF was 7.6 ± 12.5 km. Most respondents were aware of other accredited PHFs in the city and believed it was their right to choose a PHF. Among the various factors influencing their choice of index PHF were better functioning equipment (83.5% of respondents), more specialists/trained health workers (78.5%), ease in receiving specialist care (69.4%), and better overall quality of care (78.9%). Conclusion: There are multiple factors associated with enrollee choice of PHF in this study. The NHIS enrollees value the presence of functioning equipment/facilities, ease in receiving specialist care, and overall high quality of care in their choice of PHF. Improving enrollee enrollment at accredited PHF may require addressing these factors.
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Akweongo, Patricia, Samuel Tamti Chatio, Richmond Owusu, Paola Salari, Fabrizio Tedisio, and Moses Aikins. "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 16, no. 3 (March 2, 2021): e0247397. http://dx.doi.org/10.1371/journal.pone.0247397.
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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.
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Badu, Eric, Peter Agyei-Baffour, Isaac Ofori Acheampong, Maxwell Preprah Opoku, and Kwasi Addai-Donkor. "Households Sociodemographic Profile as Predictors of Health Insurance Uptake and Service Utilization: A Cross-Sectional Study in a Municipality of Ghana." Advances in Public Health 2018 (2018): 1–13. http://dx.doi.org/10.1155/2018/7814206.
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Introduction. Attempts to use health insurance in Low and Middle Income Countries (LMICs) are recognized as a powerful tool in achieving Universal Health Coverage (UHC). However, continuous enrolment onto health insurance schemes and utilization of healthcare in these countries remain problematic due to varying factors. Empirical evidence on the influence of household sociodemographic factors on enrolment and subsequent utilization of healthcare is rare. This paper sought to examine how household profile influences the National Health Insurance Scheme (NHIS) status and use of healthcare in a municipality of Ghana. Methods. A cross-sectional design with quantitative methods was conducted among a total of 380 respondents, selected through a multistage cluster sampling. Data were collected using a semistructured questionnaire. Data were analysed using descriptive and multiple logistics regression at 95% CI using STATA 14. Results. Overall, 57.9% of respondents were males, and average age was 34 years. Households’ profiles such as age, gender, education, marital status, ethnicity, and religion were key predictors of NHIS active membership. Compared with other age groups, 38–47 years (AOR 0.06) and 58 years and above (AOR = 0.01), widow, divorced families, Muslims, and minority ethnic groups were less likely to have NHIS active membership. However, females (AOR = 3.92), married couples (AOR = 48.9), and people educated at tertiary level consistently had their NHIS active. Proximate factors such as education, marital status, place of residence, and NHIS status were predictors of healthcare utilization. Conclusion. The study concludes that households’ proximate factors influence the uptake of NHIS policy and subsequent utilization of healthcare. Vulnerable population such as elderly, minority ethnic, and religious groups were less likely to renew their NHIS policy. The NHIS policy should revise the exemption bracket to wholly cover vulnerable groups such as minority ethnic and religious groups and elderly people at retiring age of 60 years.
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Shobiye, Hezekiah Olayinka, Ibironke Dada, Njide Ndili, Emmanuella Zamba, Frank Feeley, and Tobias Rinke de Wit. "Determinants and perception of health insurance participation among healthcare providers in Nigeria: A mixed-methods study." PLOS ONE 16, no. 8 (August 4, 2021): e0255206. http://dx.doi.org/10.1371/journal.pone.0255206.
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Background To accelerate universal health coverage, Nigeria’s National Health Insurance Scheme (NHIS) decentralized the implementation of government health insurance to the individual states in 2014. Lagos is one of the states that passed a State Health Insurance Scheme into law, in order to expand the benefits of health insurance beyond the few residents enrolled in community-based health insurance programs, commercial private health insurance plans or the NHIS. Public and private healthcare providers are a critical component of the Lagos State Health Scheme (LSHS) rollout. This study explored the determinants and perception of provider participation in health insurance programs including the LSHS. Methods This study used a mixed-methods cross sectional design. Quantitative data were collected from 60 healthcare facilities representatively sampled from 6 Local Government Areas in Lagos state. For the qualitative data, providers were interviewed using structured questionnaires on selected characteristics of each health facility in addition to the managers’ opinions about the challenges and benefits of insurance participation, capacity pressure, resource availability and financial management consequences. Results A higher proportion of provider facilities participating in insurance relative to non-participating facilities were larger with mid to (very) high patient volume, workforce, and longer years of operation. In addition, a greater proportion of private facilities compared to public facilities participated in insurance. Furthermore, a higher proportion of secondary and tertiary facilities relative to primary facilities participated in insurance. Lastly, increase in patient volume and revenue were motivating factors for provider facilities to participate in insurance, while low tariffs, delay and denial of payments, and patients’ unrealistic expectations were mentioned as inhibiting factors. Conclusion For the Lagos state and other government insurance schemes in developing countries to be successful, effective contracting and quality assurance of healthcare providers are essential. The health facilities indicated that these would require adequate and regular provider payment, investments in infrastructure upgrades and educating the public about insurance benefit plans and service expectations.
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Umar, Suraiya, Adam Fusheini, and Martin Amogre Ayanore. "The shared experiences of insured members and the uninsured in health care access and utilization under Ghana’s national health insurance scheme: Evidence from the Hohoe Municipality." PLOS ONE 15, no. 12 (December 23, 2020): e0244155. http://dx.doi.org/10.1371/journal.pone.0244155.
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Background The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 to remove financial barriers and to promote equitable access to health care services. Post implementation has been characterized by increases in access and utilization of services among the insured. The uninsured have been less likely to utilize services due to unaffordability of health care costs. In this study, we explored the experiences of the insured members of the NHIS, the uninsured and health professionals in accessing and utilizing health care services under the NHIS in the Hohoe Municipality of Ghana. Methods Qualitative in-depth interviews were held with twenty-five NHIS insured, twenty-five uninsured, and five health care professionals, who were randomly sampled from the Hohoe Municipality to collect data for this study. Data was analyzed using thematic analysis. Results Participants identified both enablers or motivating factors and barriers to health care services of the insured and uninsured. The major factors motivating members to access and use health care services were illness severity and symptom persistence. On the other hand, barriers identified included perceived poor service quality and lack of health insurance among the insured and uninsured respectively. Other barriers participants identified included financial constraints, poor attitudes of service providers, and prolonged waiting time. However, the level of care received were reportedly about the same among the insured and uninsured with access to quality health care much dependent on ability to pay, which favors the rich and thereby creating inequity in accessing the needed quality care services. Conclusion The implication of the financial barriers to health care access identified is that the poor and uninsured still suffer from health care access challenges, which questions the efficiency and core goal of the NHIS in removing financial barrier to health care access. This has the potential of undermining Ghana’s ability to meet the Sustainable Development Goal 3.8 of universal health coverage by the year 2030.
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Domapielle, Maximillian Kolbe, Constance Awinpoka Akurugu, and Emmanuel Kanchebe Derbile. "Vertical equity in access to health insurance services: An exploration of perceptions and enrolment in the Jirapa Municipality, north-western Ghana." Journal of Planning and Land Management 2, no. 1 (April 15, 2021): 1–12. http://dx.doi.org/10.36005/jplm.v2i1.28.
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Given concerns about the spiralling cost of health services in low and middle-income countries (LMICs), this study draws on a framework for assessing poverty and access to health services to ascertain progress towards achieving vertical equity in the National Health Insurance Scheme (NHIS) in a rural setting in northern Ghana. Rural-urban disparities in financial access to NHIS services are seldom explored in equity-related studies although there is a knowledge gap of progress and challenges of implementing the scheme’s vertical equity objectives to inform social health protection planning and implementation. A qualitative approach was used to collect and analyse the data. Specifically, in-depth interviews and observation were deployed to explore participants’ lived experiences, the relationship between location, livelihoods and ability to pay for health insurance services. The article found that flat rate contributions for populations in the informal sector of the economy and lack of flexibility and adaptability of timing premium collections to the needs of rural residents make the cost of membership disproportionately higher for them, and this situation contradicts the vertical equity objectives of the NHIS. The study concludes that the current payment regimes serve as important deterrence to poor rural residents enrolling in the scheme. Based on this, we advocate strict adherence and implementation of the scheme’s vertical equity measures through the adoption of the Ghana National Household Register (GNHR) as a tool for ensuring that contributions are based on income, and collection is well-timed
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Olayemi, Olalekan Moses. "Awareness and Perception of National Health Insurance Scheme (NHIS) among Librarians’ in Nigeria." International Journal of Perceptions in Public Health 2, no. 1 (December 31, 2017): 56–63. http://dx.doi.org/10.29251/ijpph.2017128.
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Saka, S. A., and O. T. Fajemirokun. "The effects of National Health Insurance Scheme on equity and quality of diabetes care in secondary healthcare facilities in SouthWest Nigeria." Journal of Medical and Biomedical Sciences 7, no. 1 (June 1, 2018): 11–21. http://dx.doi.org/10.4314/jmbs.v7i1.2.
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There have been concerns about the influence of the National Health Insurance Scheme (NHIS) on equity and quality of diabetes care in many healthcare settings. This study aimed to assess the effects of NHIS onequity and quality of diabetes care (DC) in Nigeria. A prospective cross-sectional study was carried out among 110 (insured n=42, uninsured=68) consenting type 2-diabetics. Diabetic outpatients on oral hypoglycemic drugs, with at least 4 clinic visits prior to the time of the study were consecutively selected at two NHIS accredited public hospitals in Southwest, Nigeria. Patients’ perceptions of equity and quality of DC were assessed using a validated 27 items questionnaire. The medical care and pharmaceutical care in diabetes were independently assessed using medical chart review and a direct observation of dispensing pharmacists’ activities respectively. Chi-squared test was used to determine associations between variables. Majority (61.8%) of the study participants were uninsured. Females (50.9%) were more than the males (49.1%), 40.0% had post-secondary qualifications. The mean ages for the insured and uninsured were 52.02±11.6 and 58.97± 9.3years respectively. The insured and the uninsured differ in their perceptions of drug availability (p<0.001). The pharmacists’ counselling time (p<0.001) differs between the groups. The quality of medical care provided to the diabetics was generally low. The NHIS did not influence the quality of DC, though it may have engendered inequity in pharmaceutical care in the facilities.Journal of Medical and Biomedical Sciences (2018) 7(1), 11 - 21
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Obi, Ikechukwu Vincent, Ijeoma Lewechi Okoronkwo, Emmanuel Chukwunonye Azuike, Kamtoochukwu Maduneme Obi, and Ifunanya Rosemary Obi. "Extent of Healthcare Provider Adherence to National Health Insurance Scheme (NHIS) Operational Guidelines: The Nigeria Experience." Journal of Public Administration and Governance 9, no. 3 (September 19, 2019): 239. http://dx.doi.org/10.5296/jpag.v9i3.15279.
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The main objective of the National health insurance programme is to improve the health status of the populace in Nigerians. The healthcare provider provision of services in the programme has become a source of worry to government and other stakeholders. This study therefore sets out to examine the extent of healthcare provider adherence to NHIS operational guidelines. Design/Methodology: This is a cross-sectional survey using a questionnaire method. Sample size was calculated (demand side) using G-power 3.1 software and (supply side) Cochran formular and the calculated sample sizes were 1435 and 46 respectively. Multistage sampling technique was applied. Variables were analyzed using descriptive and T- test statistics with SPSS version 25. Result: Out of the 1435 enrollees 80% disagreed that providers provide laboratory services. Also, 91% of them disagreed that providers provide prescribed drugs. In contrast, both the enrollee (67%) and providers (69%) agreed that providers are polite while providing services. The Test value was set at 75%. The calculated T value for operational guideline for enrollees was 70.81 (p<0.05) on the opinion of the enrollees on extent of provider provision of services. The calculated T-value for operational guideline for providers was 2.40 (p<0.05) on the opinion of providers on the provision of services. Conclusion: The evidence from this study have identified areas in the service provision to be addressed by policy makers and in contrast showed that both the enrollees and providers agreed overall that the healthcare providers adhere to NHIS operational guideline.
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Ramadani, R. V., H. Thabrany, and A. E. Putri. "Inequities of Access, Utilization and Clinical Outcome of Lung Cancer in Indonesia." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 83s. http://dx.doi.org/10.1200/jgo.18.16200.
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Background: Indonesia integrated all social health insurance and social assistance program into the National Health Insurance Scheme (NHIS) aiming to achieve universal health coverage by 2019. Currently, 194 million people are registered in the NHIS. Lung cancer absorbed a significant amount of the NHIS Indonesia and one of the leading cause of deaths among men in Indonesia. Lung cancer is rising major public health concern due to a high prevalence of smokers yet most lung cancer is diagnosed at late stage leading to short survival rate in Indonesia. Aim: This study aimed at investigating access, utilization, and clinical outcomes of lung cancer's patients. The second aim is to investigate differences in access to treatments of lung cancer patients among different member groups of the NHIS. Methods: The data were drawn from a 2014-2015 claim of the NHIS. The number of lung cancer patients of the outpatient's care was 5939 in 2014 and was 6595 in 2015. The number of inpatients diagnosed with lung cancer was 8969 and 9455 respectively for 2014 and 2015. Descriptive analysis was performed to investigate the differences in access, utilization (consumption), and in clinical outcome across class and membership. Results: Access to treatment of lung cancer patients was 0.5 for outpatient care and 0.7 for inpatient care per 10,000 members. This prevalence was higher compared with the national reported prevalence of lung cancer which was 0.3 per 10,000 populations. However, access and utilization among poorer members (third class and PBI membership) were only 0.1 for outpatient and 0.2 for inpatient per 10,000 members. The quality of treatment mortality and self-discharges were 6.04% and 5.68% compared with the higher class of members which account for 0.48% and 2.31% in 2015. Conclusion: There were inequities in access, utilization, and clinical outcomes among lung cancer patients suggesting disparities of supplies side and nonfinancial barriers among lower socioeconomic groups. The authors suggest the national and local governments should accelerate to produce oncologists and subnational cancer centers to ensure access among NHIS members.
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Novignon, Jacob, Yaw Boateng Atakorah, and Gowokani Chijere Chirwa. "Exemption for the poor or the rich? An assessment of socioeconomic inequalities in Ghana’s national health insurance exemption policies." Health Policy and Planning 36, no. 7 (May 29, 2021): 1058–66. http://dx.doi.org/10.1093/heapol/czab059.
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Abstract Out-of-pocket payments for health are considered a major limitation to universal health coverage (UHC). Policymakers across the globe are committed to achieving UHC through the removal of financial barriers to health care. In Ghana, a national health insurance scheme was established for this purpose. A unique feature of the scheme is its premium exemption policies for vulnerable groups. In this article, we access the nature of socioeconomic inequality in these exemption policies. We used data from the Ghana Living Standards Survey rounds six and seven. Socioeconomic inequality was assessed using concentration curves and indices. Real household annual total consumption expenditure adjusted by adult equivalence scale was used as a wealth indicator. Four categories of exemption were used as outcome variables. These were exemptions for indigents, individuals <18 years, the aged and free maternal service. The analysis was also disaggregated by rural and urban locations of individuals. We found that while overall national health insurance scheme (NHIS) coverage was concentrated among the wealthy, all categories of premium exemption were concentrated among the poor. There was also evidence of a general decline in the magnitude of inequality over the survey years. With the specific exemptions, inequalities in exemption for indigents and maternal services were most relevant in rural locations, while inequalities in exemption for individuals <18 years and the aged were significant in urban areas. The findings suggest that the exemption policies under the NHIS are generally progressive and achieve the objective of inclusion for the underprivileged. However, it also provides lessons for better targeting and effective implementation. There may be a need for separate efforts to better target individuals in rural and urban locations to improve enrolment.
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Olamuyiwa, Temitope Esther, and Foluke Olukemi Adeniji. "Patient’s Satisfaction With Quality of Care at a National Health Insurance Clinic at a Tertiary Center, South-South Nigeria." Journal of Patient Experience 8 (January 1, 2021): 237437352098147. http://dx.doi.org/10.1177/2374373520981471.
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Introduction: Patient satisfaction is a commonly used indicator for measuring the quality of health care. This study assessed patients’ satisfaction with the quality of care at the National Health Insurance Scheme (NHIS) clinic in a tertiary facility. Methods: It was a descriptive cross-sectional study in which 379 systematically selected participants completed an interviewer-administered, semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 23. Bivariate analysis was performed using Pearson χ2 with a P value set at ≤ .05. Results: The study found out that about half (193, 50.9%) of the respondents were satisfied with the availability of structure. Patients were not satisfied with waiting time in the medical records, account, laboratory, and pharmacy sections. Overall, 286 (75.5%) of the respondents were satisfied with the outcome of health care provided at the NHIS clinic. A statistically significant association ( P = .00) was observed between treatment outcome and patient satisfaction. Conclusion: There is a need to address structural deficiencies and time management at the clinic.
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Ajibola, Saka S., and Fajemirokun O. Timothy. "The Influence of National Health Insurance on Medication Adherence Among Outpatient Type 2 Diabetics in Southwest Nigeria." Journal of Patient Experience 5, no. 2 (September 29, 2017): 114–19. http://dx.doi.org/10.1177/2374373517732384.
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Purpose: Medication adherence (MA) is a challenge among patients with chronic diseases worldwide. Little has been reported on the influence of National Health Insurance Scheme (NHIS) on MA among diabetic patients in Nigeria. Objective: To assess the influence of NHIS on MA among outpatient type 2 diabetics in 2 public secondary health facilities in Southwest Nigeria. Method: A cross-sectional study involving 110 consecutively selected outpatient type 2 diabetics (insured, n = 42; uninsured, n = 68) was carried out. The patients’ perceptions of care and the influence of drug cost on MA between the insured and uninsured were compared. The patients’ perceptions of care were assessed using a 25-item pretested questionnaire. The MA was measured using the Morisky MA-8 scale. The use of oral antidiabetic drugs (OADs) was evaluated using a medical chart review. Information about patients’ sociodemographics, year of diagnosis, comorbidities, and types of OADs prescribed was retrieved from the medical records. Descriptive statistics were used for data presentation. A Pearson χ2 was used for test of associations. P values < .05 were considered significant. Results: Majority of the respondents (68 [61.8%]) were uninsured. The insured and the uninsured patients differed in their perceptions of the adequacy of time used by pharmacists for medication counseling ( P < .0005). The MA between the groups also differs ( P = .0002). The monthly drug cost for OADs was significantly associated with MA ( P = .037). Conclusion: The study concluded that the NHIS may positively influence MA among diabetic patients. The drug cost may have contributed significantly to the difference in MA between the groups. More time should be devoted to the counseling of the uninsured patients.
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Williams, Gemma A., Divya Parmar, Fahdi Dkhimi, Felix Asante, Daniel Arhinful, and Philipa Mladovsky. "Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana." Social Science & Medicine 186 (August 2017): 10–19. http://dx.doi.org/10.1016/j.socscimed.2017.05.023.
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Aminu, Hamajoda. "Propagating health insurance: A formative evaluation of broadcast media programs sponsored by National Health Insurance Scheme (NHIS) in selected Northern States." Journal of Media and Communication Studies 7, no. 9 (November 30, 2015): 159–70. http://dx.doi.org/10.5897/jmcs2015.0465.
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Okoro, Roland, Chijioke Nmeka, and Patrick O. Erah. "Utilization Study of Antihypertensive Medicines Among Insured Patients at a Public Tertiary Healthcare Facility in Nigeria." RADS Journal of Pharmacy and Pharmaceutical Sciences 7, no. 4 (January 30, 2020): 174–80. http://dx.doi.org/10.37962/jpps.v7i4.320.
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Background: Access to essential medicines through health insurance contributes substantially towards achieving hypertension control in hypertensive sub-population of a nation.
Objectives: This study aimed to estimate the gender-based antihypertensive medicines use, to describe utilization patterns, and to estimate prescribing adherence to the health insurance guideline.
Methods: A descriptive, cross-sectional, retrospective review of paper-based prescriptions with at least an antihypertensive medicine written for insured outpatients from 1st January – 31st December 2013 at a Nigerian Federal Teaching Hospital was conducted. The prescription volume and Anatomic Therapeutic Chemical/Defined Daily Dose (DDD) methodology was used to estimate the extent of utilization of antihypertensive medicines among the study population. Drug utilization ninety percent (DU90%) was used to quantify the index of adherence to the National Health Insurance Scheme (NHIS) guideline. Differences in proportions were investigated with Pearson chi-square test (χ2). A p-value of less than 0.05 was considered statistically significant.
Results: Females recorded significantly higher antihypertensive medicines use compared to their male counterparts (61.5% versus 38.5%, p < 0.05). Diuretics (32.1% and 9935.28 DDD) and calcium channel blockers (32.1% and 8286 DDD) were the most commonly prescribed and utilized antihypertensive medicine classes. The index of adherence to the NHIS standard treatment guideline is 80.7%.
Conclusion: This study showed that diuretics (most frequently hydrochlorothiazide) and calcium channel blockers (most frequently amlodipine) were the most utilized antihypertensive medicine classes. Physicians’ prescribing patterns fell below the hundred percent benchmark of the country’s National Health Insurance programme guideline with respect to antihypertensive medicines.
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Plahar, Robert Teye, Dai Baozhen, Abubakar Saddiqque, and Sandra Asantewaa Mensah. "Experiences of the Insured and Non-Insured of the NHIS in Accessing Health-care in Tema, Ghana." Journal of Public Administration and Governance 10, no. 1 (February 3, 2020): 86. http://dx.doi.org/10.5296/jpag.v10i1.16130.
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The study analyzes the impacts emanating from the National Health Insurance Scheme in its attempt to ensuring that Ghanaians can access quality and affordable health-care. The study focuses on three hospitals; CJ Medical Centre, Sakumono Community Hospital and Tema General Hospital in the Tema, Ghana.To realize the objectives, the study applies a mixed approach to collecting and analyzing data. An interview guide and semi-structured criteria are used in the collection of data. The collected data included qualitative and quantitative data and were analyzed using color coding based on emerging themes and SPSS 18 respectively. The study was able to establish that, comparatively, people insured by the NHIS have enhanced accessibility when it comes to health-care, than the non-insured. The insured enjoy benefits from the Scheme and together with their children below 18 years enjoy free laboratory, OPD dispensary and consultation services, and some surgical procedures in both private and public hospitals.On the contrary, the non-insured have no option other than paying for the same services when in need of medical attention. However, non-insured who have cash at the ready are readily attended to while those enrolled on the NHIS may have to wait a bit longer to be served.Recommendations include authorities ensuring claims are settled promptly, expansion of number of drugs and conditions covered by the NHIS, reduction in premiums and measures to ensure health workers are not biased against the insured.
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Oyekale, Abayomi Samuel. "Factors Influencing Households’ Willingness to Pay for National Health Insurance Scheme (NHIS) in Osun State, Nigeria." Studies on Ethno-Medicine 6, no. 3 (December 2012): 167–72. http://dx.doi.org/10.1080/09735070.2012.11886435.
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Abor, Patience Aseweh, and Joshua Yindenaba Abor. "Implications of COVID-19 Pandemic for Health Financing System in Ghana." Journal of Health Management 22, no. 4 (December 2020): 559–69. http://dx.doi.org/10.1177/0972063420983096.
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This article examined the impact of the COVID-19 pandemic on the health financing system in Ghana. The COVID-19 pandemic presents two different crises—a health crisis and an economic crisis, and these have implications for the health financing system in Ghana. The pandemic is likely to have adverse effects on the various sources of healthcare financing, including government support, donor support, national health insurance scheme (NHIS) and out-of-pocket payments, which will impact the general delivery of healthcare in the country. Government support to the health sector in general is likely to be rechannelled into fighting the pandemic considering the declining tax and other non-tax revenues as well as huge expenditure commitment. Donor support is also likely to be scaled down and existing funds redirected into dealing with the COVID-19 pandemic. The NHIS will be affected, as many subscribers are not likely to renew their health insurance policies because of the fear of contracting the coronavirus when they visit health facilities. Also, the non-attendance at health facilities by health consumers will impact out-of-pocket payments and the hospitals’ ability to generate sufficient internal resources for their operations. A number of useful recommendations are proffered with the aim of improving health financing system in Ghana during and post-COVID-19 pandemic.
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Kusi, Anthony, Ama Fenny, Daniel Kojo Arhinful, Felix Ankomah Asante, and Divya Parmar. "Determinants of enrolment in the NHIS for women in Ghana – a cross sectional study." International Journal of Social Economics 45, no. 9 (September 10, 2018): 1318–34. http://dx.doi.org/10.1108/ijse-10-2016-0291.
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Purpose The National Health Insurance Scheme (NHIS) was introduced in 2005 to provide equitable access to healthcare. Furthermore, concessions were made for pregnant women, yet inequities in access continue to exist. The purpose of this paper is to explore whether dimensions of social exclusion explain why some groups of women are not benefitting from the scheme. Design/methodology/approach Data were collected from 4,050 representative households in five districts. Logistic regression is used to examine the factors that determine enrolment of women under the NHIS. Findings The study sample consists of a sub-sample of 3,173 women out of whom 58 per cent were insured. The majority (64.9 per cent) of the women were in the reproductive age (15–45 years). The results show that wealth status, age, health status, locality, perception about the quality of care at health facilities and perception of the NHIS, are the key factors that determine enrolment into the scheme. Practical implications By conceptualising social exclusion as the multi-dimensional processes driven by unequal power relationships which lead to differential inclusion and exclusion in social systems, the study provides evidence to show that certain groups of women are systemically excluded from participating in the NHIS. Social implications With women dominating the informal sector of Ghana’s economy which is often characterised by relatively low incomes, these inequities in access need to be addressed. Originality/value Although gender equality incorporates discussions on issues affecting men and women this paper focusses on women in Ghana due to disadvantaged position in which many of them find themselves in terms of access to resources. Almost all of the identified barriers in previous studies have been worsened by gender with women generally facing greater difficulties in accessing adequate care. Few of these papers have taken account the specific health needs and gender-specific constraints of women in the NHIS. The authors aim to fill this gap by using a social exclusion lens to explore whether Ghanaian women (i.e. 15 years and above) are participating in the NHIS and examine the processes by which exclusion occurs and what explains the patterns observed.
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Mohammed, Shafiu, and Hengjin Dong. "Tackling Millennium Development Goals (MDGs) 4 and 5: the National Health Insurance Scheme (NHIS) approach in Nigeria." Journal of Public Health in Africa 3, no. 1 (March 7, 2012): 9. http://dx.doi.org/10.4081/jphia.2012.e9.
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Acquah-Hagan, Gertrude, Daniel Boateng, Emmanuel Appiah-Brempong, Peter Twum, Joseph Amankwa Atta, and Peter Agyei-Baffour. "Access Differentials in Primary Healthcare among Vulnerable Populations in a Health Insurance Setting in Kumasi Metropolis, Ghana: A Cross-Sectional Study." Advances in Public Health 2021 (July 27, 2021): 1–14. http://dx.doi.org/10.1155/2021/9911436.
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Background. Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals in Ghana. There still remain inequalities in the distribution of health services especially among vulnerable groups despite sustained efforts to strengthen the health system. This study was conducted to analyze access differentials among different vulnerable groups in the context of primary healthcare under a National Health Insurance Scheme (NHIS) in Ghana. Methods. This study was a descriptive cross-sectional study conducted among multilevel participants of vulnerable groups in Kumasi Metropolis: 710 vulnerable people constituting elderly/aged (n = 359), pregnant women (n = 117), head poters (teenage girls who migrated from the northern Ghana mainly to the capital cities of the Ashanti and Greater Accra region to help in carrying of goods for their livelihood) (n = 86), sex workers (n = 75), and other vulnerable groups (people with disabilities and street participants) (n = 73). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to access the association between vulnerability and access to healthcare. Results. Close to a fifth, 18.5% of the study respondents were unable to access care at any point in time during the last 12 months. Reasons for the inability to access healthcare included limited funding (69.7%), poor attitude of service providers (7.6%), distance to health centers (8.3%), and religious reasons (6.2%). More than 95% of respondents were insured under the NHIS, but acceptability of service provision under the NHIS was low among the vulnerable groups. In the crude models, pregnant women had lower prevalence of access to medications as compared to the elderly (prevalence ratio (PR): 0.88; 95% CI: 0.80–0.98). Head poters and other vulnerable groups were also less likely to view healthcare as affordable as compared to the elderly. The differences in healthcare access observed were attenuated after adjustment for sociodemographic characteristics and healthcare-related factors. Conclusions. Despite the introduction of a NHIS in Ghana, this study highlights challenges in healthcare access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to work to address access differentials in the NHIS and adopt other innovative care strategies that may have broader applicability for all populations.
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Kiyoya, Yohana Andeshi. "Assessing Beneficiaries’ Healthcare Satisfaction under National Health Insurance in Dar es Salaam Region, Tanzania." Policy & Governance Review 3, no. 2 (June 11, 2019): 91. http://dx.doi.org/10.30589/pgr.v3i2.128.
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This research is based on an empirical study of NHIF beneficiaries on the quality of healthcare received under the scheme. It investigates the extent of healthcare satisfaction as perceived by principal beneficiaries on various factors influencing healthcare, and examined challenges facing the scheme as per beneficiaries’ opinion. This research used survey method for data collection. The analysis is done using primary data from the questionnaire, which were distributed to 152 NHIF beneficiaries (employee) at the National Identification Authority (NIDA) in October 2018. Data collection instrument included a Google-based questionnaire with closed questions. Data were analyzed quantitatively using descriptive statistics (Quantitative descriptive study design). The study found unsatisfactory results on some of the services given by the scheme such as a number of dependents covered, the range of diseases covered, time for treatment intervention, time to wait for diagnostic tests, an appointment with the specialists, and time to retrieve files. It also examined budget constraints, public awareness, and acceptance of the scheme, corruption, and embezzlement as the challenge facing the scheme.
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Addo, Rebecca, Justice Nonvignon, and Huihui Wang. "VP36 Benefit Cost Analysis Of Electronic Claims Processing System In Ghana." International Journal of Technology Assessment in Health Care 34, S1 (2018): 168–69. http://dx.doi.org/10.1017/s0266462318003513.
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Introduction:Since the inception of the Ghana National Health Insurance Scheme (NHIS), it has been pursuing a number of provider payment mechanisms that could not only control the continuous escalating costs of claims payout, but also facilitate the claims processing time. In lieu of this, electronic processing of claims (E-claims) was introduced in 2013 as part of the World Bank supported Health Insurance project that sought to facilitate the financial and operational management of the NHIS. It was piloted in 29 health facilities up to March 2014. They reported cost savings made by the NHIS using E-claims, creating interest in scaling it up. However, the comparative effectiveness and cost effectiveness of E-claims to the health system compared to manual claims processing is unknown. Therefore, to provide decision makers with the appropriate information to choose between manual and E-claims processing, this study sought to evaluate the cost-benefit of E-claims.Methods:A benefit-cost analysis was used to evaluate the efficiency of E-claims from the perspective of the health system. Health providers and the purchaser (NHIS claims processing center) were the study population. Resource use and costs were obtained from the study population. The volumes and values of claims reimbursed and the claims rejection rate were used as the benefits of claims processing. The incremental benefit-cost ratio (IBCR) was estimated for the provider, purchaser and the entire health system. Analysis was conducted in Microsoft Excel.Results:The total cost per claim for providers were USD 1,177.04 and USD 1,240.65 for E-claims and paper claims respectively. The total cost per E-claims and paper claims for the purchaser were 592.17 and 502.19 respectively. Total benefit per E-claim and paper claim processing for the providers were USD 8,562.90 and USD 8,888.37 respectively while that for the purchaser was USD 11,037.62 and USD 8,737.60 respectively. Processing claims electronically led to incremental gains by both providers and purchasers. Providers gained additional USD 2008.51 while the purchaser gained USD 2,300.02. The IBCR was estimated at −19.75, 25.56 and 5.10 for all providers, purchaser and both providers and purchaser of the health system respectively. Thus the IBCR was less than 1for the providers and more than 1 for purchaser and both purchaser and providers.Conclusions:The electronic processing of claims is more efficient compared to manual processing in the Ghana NHIS. This provides decision makers with evidence for scaling it up to all the facilities in Ghana.
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Abdulganiyu, Giwa, Kabir Muhammad, Umar Ibrahim, Suleiman HH, and Lawal BK. "Awareness and Willingness to Pay for Community Based Health Insurance Scheme in North-Western Nigeria." Bangladesh Journal of Medical Education 9, no. 2 (November 28, 2018): 19–23. http://dx.doi.org/10.3329/bjme.v9i2.39000.
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There is a need for the communities to develop their health financing system, most especially those that were not covered by the National Health Insurance Scheme (NHIS). This will give the people an opportunity to finance their medical care which in turn would alleviate financial burden at the point of treatment. Therefore, this study is aimed to determine the level of awareness for Community Based Health Insurance Scheme (CBHIS) among communities and to measure the degree of willingness to pay for the scheme in Katsina, North-Western Nigeria. Semi structured interviewer-assisted questionnaires were used to collect information from the respondents. Statistical analyses were performed using SPSS version 20.0. The results indicates that majority of the respondents attained tertiary level of education (68.3%) and 81.1% were employed. About 74.2% were earning more than the Nigerian minimum wage N18, 000 (≈$59). About 52.2% of the respondents were aware of the CBHIS. And 81% were willing to pay for premium while 62.2% will pay between N 1, 000 – 5, 000 (≈$3.3- $16.4). There was strong significant relationship between monthly income and knowledge of CBHIS (p = < 0.0001). However, gender and educational level were not significantly associated with the knowledge of CBHIS. Awareness about CBHIS was not sufficiently adequate but a significant number of the respondents were willing to pay for CBHIS after learning about the scheme. Factors such as level of education and income levels were found to have positive effect on willingness to pay.Bangladesh Journal of Medical Education Vol.9(2) 2018: 19-23
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Bamfo, Bylon Abeeku, and Courage Simon Kofi Dogbe. "Factors influencing the choice of private and public hospitals: empirical evidence from Ghana." International Journal of Pharmaceutical and Healthcare Marketing 11, no. 1 (April 3, 2017): 80–96. http://dx.doi.org/10.1108/ijphm-11-2015-0054.
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Purpose The study aims to examine the factors influencing the choice of private and public hospitals in Ghana. Design/methodology/approach Purposive and convenient sampling techniques were used in selection of 225 respondents for the study. An independent samples t-test was used in ascertaining the significant difference in the opinions of both groups. Finally, binary logistics regression was used in ascertaining the factors that significantly influenced the choice of hospitals in Ghana. Findings In Ghana, patients’ choice of private or public hospital was significantly influenced by service quality, word-of-mouth, type of ailment and National Health Insurance Scheme (NHIS). Patients who made choice decision based on service quality were more likely to attend a private hospital. Word-of-mouth influenced the choice of public hospitals more than private hospitals. Patients preferred visiting public hospitals for more complicated ailments such as spinal defects, HIV/AIDS, heart-related problems, etc. Patients registered under the NHIS also preferred visiting public hospital to private hospital. Although services from private hospitals were more expensive, patients were more satisfied with services provided, as compared to patients from the public hospital. Cost of service and patient satisfaction, however, did not have a statistically significant effect on the choice of hospital. Originality/value Most comparative studies done on private and public hospitals studied in isolation focused on service quality, customer satisfaction, national health insurance and cost of health care or a combination of them. This study, however, considered all these selection criteria and extended it by adding word-of-mouth and the type of ailments suffered. The study, thus, provided a more comprehensive hospital selection criteria. The use of logistics regression in this particular area of study was also quite unique.