Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District

Nsiah-Boateng, Eric; Aikins, Moses; Asenso-Boadi, Francis; Andoh-Adjei, Francis-Xavier

doi:10.1016/j.vhri.2016.03.003

Cited by 13 publications

(23 citation statements)

References 5 publications

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“…Another plausible explanation for the low rate of adjustment is that healthcare providers themselves pre-screen their claims for errors before submitting to the CPC; an exercise that could eliminate omissions and duplications. The finding supports a study by Nsiah-Boateng et al [ 23 ]; however, it contradicts a similar study, where the proportions of claims cost adjusted were 11 and 14% for two NHIA district offices in the Upper East region of Ghana [ 15 ].…”

Section: Discussionsupporting

confidence: 65%

Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

Nsiah-Boateng

Asenso-Boadi

Dsane-Selby

et al. 2017

BMC Health Serv Res

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BackgroundA robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana.MethodsThe study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews.ResultsThe electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p < 0.001). However, there were no significant differences in claims cost adjustment rate between healthcare facility types by the electronic-based (p = 0.0656) and by the paper-based reviews (p = 0.6484).ConclusionsThe electronic-based review adjusted significantly higher claims cost than the paper-based claims review. Scaling up the electronic-based review to cover claims from all accredited care providers could reduce spurious claims cost to the scheme and ensure long term financial sustainability.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2054-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 65%

Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

Nsiah-Boateng

Asenso-Boadi

Dsane-Selby

et al. 2017

BMC Health Serv Res

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“…Many African countries particularly those in the sub-Saharan Africa (SSA) are at different stages of SHI implementation aimed at achieving UHC [ 9 , 10 ]. It is a general belief that UHC is a panacea for reducing out-of-pocket payment and inequity in access to and utilization of healthcare services [ 6 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…It was fashioned out to address the challenges of the out-of-pocket payment system of paying for healthcare services in the 1990s, popularly referred to as “cash and carry”. The cash and carry system was introduced at that time to recover at least 15% of recurrent expenditure and drugs [ 13 , 18 , 19 ] but it led to increased inequality in healthcare access and preventable deaths [ 10 , 14 , 18 , 20 ]. The NHIS is managed by the National Health Insurance Authority (NHIA), a regulatory body mandated by law to oversee operations of public and private health insurance schemes in the country [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…The NHIS is managed by the National Health Insurance Authority (NHIA), a regulatory body mandated by law to oversee operations of public and private health insurance schemes in the country [ 21 ]. Since its implementation, the NHIS has made gains in population coverage, increased access to healthcare services by reducing out-of-pocket payment and contributed to raising revenue of healthcare providers [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Trends and characteristics of enrolment in the National Health Insurance Scheme in Ghana: a quantitative analysis of longitudinal data

Nsiah-Boateng

2018

glob health res policy

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BackgroundIn 2004, Ghana started experimenting a National Health Insurance Scheme (NHIS) to reduce out-of-pocket payment for healthcare. Like many other social health insurance schemes in Africa, the NHIS is striving for universal health coverage (UHC). This paper examines trends and characteristics of enrolment in the scheme to inform policy decisions on attainment of UHC.MethodsWe conducted trend analysis of longitudinal enrolment data of the NHIS for the period, 2010–2017. Descriptive statistics were used to examine trends and characteristics of enrolment by geographical region and member groups.ResultsOver the 8-year period, the population enrolled in the scheme increased from 33% (8.2 million) to 41% (11.3 million) between 2010 and 2015 and dropped to 35% (10.3 million) in 2017. Members who renewed their membership increased from 44% to 75.4% between 2010 and 2013 and then dropped to 73% in 2017. On average, the urban regions had significantly higher number of new enrolments than the rural ones. Similarly, the urban and peri-urban regions recorded significantly higher number of renewals than the other regions. In addition, persons below the age of 18 years and the informal sector workers had significantly higher number of enrolment than any other member group.ConclusionsEnrolment in the NHIS is declining and there are significant differences among geographical regions and member groups. Managers of the NHIS need to enforce the mandatory enrolment provision in the Act governing the scheme, employ innovative strategies such as mobile phone application for registration and renewals and address delays in healthcare provider claims to improve enrolment.Electronic supplementary materialThe online version of this article (10.1186/s41256-018-0087-6) contains supplementary material, which is available to authorized users.

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“…Studies conducted in Africa on the National Health Services have focused on the fragmentation of health care delivery, which hampers the move towards universal coverage [7], benefit of the NHI to subscribers [8], and progress made towards UHC systems of Ghana, South Africa and Tanzania [9]. A study conducted among 216 dentists in Lagos, Nigeria in 2010 indicated that only 62 (28.7%) had good knowledge about the NHI System (NHIS), with the majority 152 (70.4%) viewing the NHIS as a good idea that would succeed if properly implemented [10].…”

Section: Introductionmentioning

confidence: 99%

Awareness of Health Care Practitioners About the National Health Insurance in Tshwane District, South Africa

Mabuza¹,

Ogunbanjo²,

Hlabyago³

et al. 2018

TOPHJ

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Background: In 2012, the National Department of Health of South Africa launched the National Health Insurance (NHI) pilot program in 11 districts, towards universal health coverage for all South Africans. Health Care Practitioners (HCPs) are important role-players in its implementation. We decided to evaluate to what extent the HCPs were aware of the NHI program after three years of the pilot phase. Objective: To evaluate the awareness of HCPs about the NHI in the pilot Tshwane district of South Africa. Method: A cross-sectional survey was conducted among 1753 HCPs in Tshwane district. At 95% confidence level and 5% error margin, the sample size was 315 HCPs, but we over-sampled to 480. The study was conducted in 25 health facilities within the district. A pre-tested self-administered questionnaire was used. Results: A high proportion of HCPs were unaware of the objectives of the NHI program (p < 0.001); number of NHI pilot sites [(281; 59.4%) versus (145; 30.7%), p < 0.001]; rationale used to select pilot sites [(223; 46.9%) versus (193; 40.5%), p = 0.047]; role of the Integrated School Health Services (ISHP) [(250; 52.7%) versus (70; 14.8%), p < 0.001]; and specialists constituting the District Clinical Specialist Team (DCST) (p < 0.001). However, awareness regarding the Ward-Based Outreach Team (WBOT) leader was high [(236; 49.9%) versus (135; 28.5%), p < 0.001]. Conclusion: HCPs in Tshwane district demonstrated poor awareness of the NHI. This reveals that any awareness effort towards the NHI has not taken effect among the HCPs in this district.

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Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District

Abstract: There is increased value of the NHIS benefit package to subscribers; however, the scheme's responsiveness to the financial needs of health services providers is low. This calls for a review of the NHIS policy to improve financial viability and service quality.

Cited by 13 publications

References 5 publications

Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

Reducing medical claims cost to Ghana’s National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews

Trends and characteristics of enrolment in the National Health Insurance Scheme in Ghana: a quantitative analysis of longitudinal data

Awareness of Health Care Practitioners About the National Health Insurance in Tshwane District, South Africa

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