Disparities between Explanatory Models of Health Clients, Healthcare Providers and Health Insurer

Abstract

Abstract:We present qualitative data from a study in Ghana (2011), where the National Health Insurance Scheme (NHIS) was introduced to improve access to health care. In 2011 membership enrolment and retention in the scheme was stalling. To obtain better insights into socio-cultural factors that influence utilization of healthcare services and the NHIS this study compared Explanatory Models of healthcare clients with those of primary healthcare providers and the NHIS regarding illness, the need for, the quality of, and the control over healthcare and health insurance services. We found critical disparities in socio-cultural beliefs and perceptions of healthcare and health insurance between these three stakeholder groups, such as the clients' holistic view on illness versus healthcare providers' bio-medical view; the clients' inter-relational focus in perceiving quality of services versus the providers' medical technical focus. These differences are leading to misconceptions, blame practice, poor services, non-adherence and low trust. The findings increase our understanding of clients' behavior and that of their service providers. We conclude with key messages for policy leaders and operational managers that can guide them in improving services and facilitating client trust and interest to participate in health insurance and utilize healthcare services.

The Effect of Community Engagement on Healthcare Utilization and Health Insurance Enrolment in Ghana Results from a Randomized Experiment

“…The intervention design was based on the premise that involving clients in planning, provision and monitoring of healthcare and health insurance services is an important ingredient for increased healthcare utilization and health insurance enrolment because engagement ensures better understanding of the service delivery processes, builds risk awareness among clients and improves service quality [14,25]. Moreover, a qualitative study conducted at the start of the project with clients, providers and insurers revealed that perceptions on what constitutes good quality services differ among these three actors [26]. Improved mutual understanding would enable providers and insurers to address non-technical quality concerns as perceived by clients.…”

“…Community Engagement uses existing community groups or associations in assessing healthcare providers and the NHIS district offices to identify service quality gaps. The assessment employed elements of the MyCare tool [26]. The MyCare tool is an instrument used to elicit clients' perception of service quality.…”