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The challenges faced by African countries that have pioneered a national health insurance scheme (NHIS) and the lessons learned can be of great value to other countries, contemplating the introduction of such a health financing system. In 2003, Ghana initiated the NHIS to provide access to healthcare for people in both the formal and informal sectors. The paper assesses the applicability of four theoretical models to explain the perceptions and decisions of Ghanaians to participate in the NHIS. To contextualize these models, we used qualitative data from individual and group interviews of Ghanaians. These interviews form part of the study "towards a client-oriented health insurance system in Ghana" to explain the uptake of the Ghanaian social health insurance. The paper argues for a new integrated model to provide a better understanding of clients' perceptions on illness, healthcare and health insurance. Such a model should highlight trust as a fundamental factor influencing the decision of Ghanaians to enroll in the NHIS.

Background: The role for the private sector in health remains subject to much debate, especially within the context of achieving universal health coverage. This roundtable discussion offers diverse perspectives from a range of stakeholders -a health funder, a representative from an implementing organization, a national-level policy-maker, and an expert working in a large multi-national company -on what the future may hold for the private sector in health.

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