The effect of the National Health Insurance Scheme (NHIS) on health service delivery in mission facilities in Ghana: a r
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RESEARCH
Open Access
The effect of the National Health Insurance Scheme (NHIS) on health service delivery in mission facilities in Ghana: a retrospective study Genevieve Cecilia Aryeetey1, Justice Nonvignon1, Caroline Amissah2, Gilbert Buckle2 and Moses Aikins1*
Abstract Background: In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) to minimize out-of-pocket expenditure at the point of use of service. The implementation of the scheme was accompanied by increased access and use of health care services. Evidence suggests most health facilities are faced with management challenges in the delivery of services. The study aimed to assess the effect of the introduction of the NHIS on health service delivery in mission health facilities in Ghana. We conceptualised the effect of NHIS on facilities using service delivery indicators such as outpatient and inpatient turn out, estimation of general service readiness, revenue and expenditure, claims processing and availability of essential medicines. We collected data from 38 mission facilities, grouped into the three ecological zones; southern, middle and northern. Structured questionnaires and exit interviews were used to collect data for the periods 2003 and 2010. The data was analysed in SPSS and MS Excel. Results: The facilities displayed high readiness to deliver services. There were significant increases in outpatient and inpatient attendance, revenue, expenditure and improved access to medicines. Generally, facilities reported increased readiness to deliver services. However, challenging issues around high rates of non-reimbursement of NHIS claims due to errors in claims processing, lack of feedback regarding errors, and lack of clarity on claims reporting procedures were reported. Conclusion: The implementation of the NHIS saw improvement and expansion of services resulting in benefits to the facilities as well as constraints. The constraints could be minimized if claims processing is improved at the facility level and delays in reimbursements also reduced. Keywords: Health insurance, Mission facilities, Service delivery, Ghana
Background Ghana is among the first countries in sub-Saharan Africa to begin implementation of a National Health Insurance Scheme (NHIS). Until the NHIS was introduced in 2003, the country had over time implemented a number of financing reforms. These reforms - with accompanying exemption policies - included general tax revenues and user fees [1] with the latter dominating the health financing scene from the early 1970s until 2003 when a * Correspondence: [email protected] 1 University of Ghana, College of Health Science, School of Public Health, P. O. Box LG 13, Legon, Ghana Full list of author information is available at the end of the article
National Health Insurance law was passed. Subsequently in 2004, Ghana begun implementation of the NHIS as a policy objective to minimize out-of-pocket expenditure at the point of use of service [2], thus reducing the financial barrier to health service utilization. The
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