Subscribers’ perception of quality of services provided by Ghana’s National Health Insurance Scheme - what are the correlates?

Abstract

Background Ghana’s National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme. While the scheme strives to achieve universal health coverage, this quest is derailed by negative perceptions of the quality of services rendered to NHIS subscribers. This paper presents an analysis on perceptions of service quality provided to subscribers of Ghana’s NHIS with emphasis on rural and urban scheme policy holders, using a nationally representative data. Methods The study used data from the 2014 Ghana Demographic and Health Survey. Ordered logistic regressions were estimated to identify the correlates of perceived quality of care of services rendered by the NHIS. Also, chi-square statistics were performed to test for significant differences in the proportions of subscribers in the two subsamples (rural and urban). Results Rural subscribers of the NHIS were found to identify more with better perception of quality of services provided by the NHIS than urban subscribers. Results from the chi-square statistics further indicated that rural subscribers are significantly different from urban subscribers in terms of the selected socioeconomic and demographic characteristics. In the full sample; age, out-of-pocket payment for healthcare and region of residence proved significant in explaining perceived quality of services rendered by the NHIS. Age, out-of-pocket payment for healthcare, region of residence, wealth status, and access to media were found to be significant predictors of perceived quality of services provided to both rural and urban subscribers of the NHIS. The significance of these variables varied among men and women in rural and urban areas. Conclusion Different factors affect the perception of quality of services provided to rural and urban subscribers of Ghana’s NHIS. Health financing policies geared toward improving the NHIS-related services in rural and urban areas should be varied.

Trends and correlates of maternal, newborn and child health services utilization in primary healthcare facilities: an explorative ecological study using DHIMSII data from one district in the Volta region of Ghana

“…Consequently, higher health services utilization in rural locations is not always a function of improved healthcare delivery system but a reflection of lack of choice for better alternatives. Indeed, other barriers to MNCH service utilization not explored in this study are acknowledged in terms of long travel times to health facilities [24,26,29], socio-cultural beliefs [16,23,30,31] and financial inaccessibility [32][33][34][35][36][37].…”

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

“…The beneficiaries mentioned factors as well as conditions that they were not happy with health service providers (implementers). These include long hours spent at health facilities to follow health insurance ID card verification process, referrals to other facilities for drugs and medicines, referrals for diagnostic services like ultrasound scan, laboratory tests, and more access to a large volume Jointly ranked* Diagnostic Staff Attitude Prescriptions Source: Fieldwork data (FGDs at the four health facilities) Note: 1 st represents the most important service/factor, 8 th represents the least important service/factor; *Jointly ranked services -include (1 st /2 nd and 3 rd /4 th in a public hospital; 7 th and 8 th private clinic) Nketiah-Amponsah, et al, 2019;Ampaw et al, 2020;Umar et al, 2020). The conceptualisation of quality healthcare services among NHIS beneficiaries was problematic.…”

Is the National Health Insurance Scheme helping pregnant women in accessing health services? Analysis of the 2014 Ghana demographic and Health survey

“…In recent decades, several low-and middle-income countries (LMICs) have made substantial efforts to achieve this objective by introducing a number of Social Health Protection (SHP) pre-payment systems that seek to minimize dependency on out-of-pocket payments. Ghana has emerged in sub-Saharan Africa as a leader of these health financing reforms, being the first country in the sub-region to introduce a National Health Insurance Scheme (NHIS) [ 4 , 5 ].…”

“…The Government of Ghana launched the NHIS-an initiative to provide health insurance to everyone by removing the out-of-pocket payment hurdle in 2003 and this became fully operational in 2005 [ 5 , 6 ]. Health care services were paid for predominantly via consumer fees (also referred to as cash-and-carry) prior to the implementation of this program but this arrangement disenfranchised the impoverished and disadvantaged from accessing healthcare [ 7 , 8 ].…”

“…Various studies have been conducted on NHIS in Ghana. Some of these have focused on subscribers’ perception [ 5 , 15 , 16 ] and determinants of enrolment [ 6 , 17 – 22 ]. Others have also investigated the retention of subscribers [ 23 ], reducing medical claims cost [ 24 ], sustainability of the scheme [ 25 ], equity in accessibility [ 26 – 28 ], variation in coverage [ 29 ], quality healthcare assessment [ 30 ] and trends in subscription [ 13 ].…”