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Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders

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 g...

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Autores principales: Aikins, Moses, Tabong, Philip Teg-Nefaah, Salari, Paola, Tediosi, Fabrizio, Asenso-Boadi, Francis M., Akweongo, Patricia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205146/
https://www.ncbi.nlm.nih.gov/pubmed/34129630
http://dx.doi.org/10.1371/journal.pone.0253109
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author Aikins, Moses
Tabong, Philip Teg-Nefaah
Salari, Paola
Tediosi, Fabrizio
Asenso-Boadi, Francis M.
Akweongo, Patricia
author_facet Aikins, Moses
Tabong, Philip Teg-Nefaah
Salari, Paola
Tediosi, Fabrizio
Asenso-Boadi, Francis M.
Akweongo, Patricia
author_sort Aikins, Moses
collection PubMed
description 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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spelling pubmed-82051462021-06-29 Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders Aikins, Moses Tabong, Philip Teg-Nefaah Salari, Paola Tediosi, Fabrizio Asenso-Boadi, Francis M. Akweongo, Patricia PLoS One Research Article 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. Public Library of Science 2021-06-15 /pmc/articles/PMC8205146/ /pubmed/34129630 http://dx.doi.org/10.1371/journal.pone.0253109 Text en © 2021 Aikins et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Aikins, Moses
Tabong, Philip Teg-Nefaah
Salari, Paola
Tediosi, Fabrizio
Asenso-Boadi, Francis M.
Akweongo, Patricia
Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders
title Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders
title_full Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders
title_fullStr Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders
title_full_unstemmed Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders
title_short Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders
title_sort positioning the national health insurance for financial sustainability and universal health coverage in ghana: a qualitative study among key stakeholders
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205146/
https://www.ncbi.nlm.nih.gov/pubmed/34129630
http://dx.doi.org/10.1371/journal.pone.0253109
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