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Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – A qualitative study

BACKGROUND: Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices und...

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Detalles Bibliográficos
Autores principales: Ashigbie, Paul G., Azameti, Devine, Wirtz, Veronika J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765108/
https://www.ncbi.nlm.nih.gov/pubmed/26913200
http://dx.doi.org/10.1186/s40545-016-0055-9
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author Ashigbie, Paul G.
Azameti, Devine
Wirtz, Veronika J.
author_facet Ashigbie, Paul G.
Azameti, Devine
Wirtz, Veronika J.
author_sort Ashigbie, Paul G.
collection PubMed
description BACKGROUND: Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices under the NHIS as perceived by public and private service providers. METHODS: This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana between July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of public and private sector providers (government and mission hospitals, private hospitals and private standalone pharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview guides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of medicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and also in response to themes that emerged from the transcripts and notes. RESULTS: Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by removing cost barriers for patients; however, some pointed out the increased utilization could also be corollary to moral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low reimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs reported important differences between private and public sectors including weak separation of prescribing and dispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects of unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers (especially pharmacies and licensed chemical sellers) in the NHIS. CONCLUSIONS: Health providers generally perceive the NHIS to have had a largely positive impact on access to medicines. However, concerns remain about equity in access to medicines and the differences in quality of pharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the implementation of health insurance schemes is important to identify and address the potential consequences of medicines policies and practices under the scheme. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40545-016-0055-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-47651082016-02-25 Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – A qualitative study Ashigbie, Paul G. Azameti, Devine Wirtz, Veronika J. J Pharm Policy Pract Research BACKGROUND: Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices under the NHIS as perceived by public and private service providers. METHODS: This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana between July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of public and private sector providers (government and mission hospitals, private hospitals and private standalone pharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview guides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of medicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and also in response to themes that emerged from the transcripts and notes. RESULTS: Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by removing cost barriers for patients; however, some pointed out the increased utilization could also be corollary to moral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low reimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs reported important differences between private and public sectors including weak separation of prescribing and dispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects of unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers (especially pharmacies and licensed chemical sellers) in the NHIS. CONCLUSIONS: Health providers generally perceive the NHIS to have had a largely positive impact on access to medicines. However, concerns remain about equity in access to medicines and the differences in quality of pharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the implementation of health insurance schemes is important to identify and address the potential consequences of medicines policies and practices under the scheme. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40545-016-0055-9) contains supplementary material, which is available to authorized users. BioMed Central 2016-02-24 /pmc/articles/PMC4765108/ /pubmed/26913200 http://dx.doi.org/10.1186/s40545-016-0055-9 Text en © Ashigbie et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Ashigbie, Paul G.
Azameti, Devine
Wirtz, Veronika J.
Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – A qualitative study
title Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – A qualitative study
title_full Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – A qualitative study
title_fullStr Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – A qualitative study
title_full_unstemmed Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – A qualitative study
title_short Challenges of medicines management in the public and private sector under Ghana’s National Health Insurance Scheme – A qualitative study
title_sort challenges of medicines management in the public and private sector under ghana’s national health insurance scheme – a qualitative study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765108/
https://www.ncbi.nlm.nih.gov/pubmed/26913200
http://dx.doi.org/10.1186/s40545-016-0055-9
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