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The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana

BACKGROUND: Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. He...

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Autores principales: Dalinjong, Philip Ayizem, Laar, Alexander Suuk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505458/
https://www.ncbi.nlm.nih.gov/pubmed/22828034
http://dx.doi.org/10.1186/2191-1991-2-13
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author Dalinjong, Philip Ayizem
Laar, Alexander Suuk
author_facet Dalinjong, Philip Ayizem
Laar, Alexander Suuk
author_sort Dalinjong, Philip Ayizem
collection PubMed
description BACKGROUND: Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme (NHIS) to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behavior of health care providers in their treatment of insured and uninsured clients. METHODS: The study took place in Bolgatanga (urban) and Builsa (rural) districts in Ghana. Data was collected through exit survey with 200 insured and uninsured clients, 15 in-depth interviews with health care providers and health insurance managers, and 8 focus group discussions with insured and uninsured community members. RESULTS: The NHIS promoted access for insured and mobilized revenue for health care providers. Both insured and uninsured were satisfied with care (survey finding). However, increased utilization of health care services by the insured leading to increased workloads for providers influenced their behavior towards the insured. Most of the insured perceived and experienced long waiting times, verbal abuse, not being physically examined and discrimination in favor of the affluent and uninsured. The insured attributed their experience to the fact that they were not making immediate payments for services. A core challenge of the NHIS was a delay in reimbursement which affected the operations of health facilities and hence influenced providers’ behavior as well. Providers preferred clients who would make instant payments for health care services. Few of the uninsured were utilizing health facilities and visit only in critical conditions. This is due to the increased cost of health care services under the NHIS. CONCLUSION: The perceived opportunistic behavior of the insured by providers was responsible for the difference in the behavior of providers favoring the uninsured. Besides, the delay in reimbursement also accounted for providers’ negative attitude towards the insured. There is urgent need to address these issues in order to promote confidence in the NHIS, as well as its sustainability for the achievement of universal coverage.
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spelling pubmed-35054582012-11-26 The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana Dalinjong, Philip Ayizem Laar, Alexander Suuk Health Econ Rev Research BACKGROUND: Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme (NHIS) to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behavior of health care providers in their treatment of insured and uninsured clients. METHODS: The study took place in Bolgatanga (urban) and Builsa (rural) districts in Ghana. Data was collected through exit survey with 200 insured and uninsured clients, 15 in-depth interviews with health care providers and health insurance managers, and 8 focus group discussions with insured and uninsured community members. RESULTS: The NHIS promoted access for insured and mobilized revenue for health care providers. Both insured and uninsured were satisfied with care (survey finding). However, increased utilization of health care services by the insured leading to increased workloads for providers influenced their behavior towards the insured. Most of the insured perceived and experienced long waiting times, verbal abuse, not being physically examined and discrimination in favor of the affluent and uninsured. The insured attributed their experience to the fact that they were not making immediate payments for services. A core challenge of the NHIS was a delay in reimbursement which affected the operations of health facilities and hence influenced providers’ behavior as well. Providers preferred clients who would make instant payments for health care services. Few of the uninsured were utilizing health facilities and visit only in critical conditions. This is due to the increased cost of health care services under the NHIS. CONCLUSION: The perceived opportunistic behavior of the insured by providers was responsible for the difference in the behavior of providers favoring the uninsured. Besides, the delay in reimbursement also accounted for providers’ negative attitude towards the insured. There is urgent need to address these issues in order to promote confidence in the NHIS, as well as its sustainability for the achievement of universal coverage. Springer 2012-07-23 /pmc/articles/PMC3505458/ /pubmed/22828034 http://dx.doi.org/10.1186/2191-1991-2-13 Text en Copyright ©2012 Dalinjong and Laar; licensee Springer. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Dalinjong, Philip Ayizem
Laar, Alexander Suuk
The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana
title The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana
title_full The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana
title_fullStr The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana
title_full_unstemmed The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana
title_short The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana
title_sort national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of ghana
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505458/
https://www.ncbi.nlm.nih.gov/pubmed/22828034
http://dx.doi.org/10.1186/2191-1991-2-13
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