Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching

Mensah, Joseph; Oppong, Joseph R.; Schmidt, Christoph Μ.

doi:10.1002/hec.1633

Cited by 194 publications

(198 citation statements)

References 17 publications

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“…1,17,18 A number of studies report greater accessibility and fairly high levels of satisfaction with the system. [19][20][21][22] Equity in healthcare through the NHIS of Nigeria and Ghana has also been the concern of Odeyemi and Nixon's study, where they noted that in spite of Ghana's uniform benefits across all beneficiaries and improvements in equity, there is a pro-rich and pro-urban bias in membership. 23 The effects of the NHIS on healthcare utilisation has also engaged the attention of researchers with evidence that individuals enrolled on the scheme are more likely to obtain prescriptions, visit clinics and seek formal healthcare when sick.…”

Section: Summary Of the Main Elements Of Ghana's National Health Insumentioning

confidence: 99%

The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation

Fusheini

2016

Int J Health Policy Manag

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Background: National/social health insurance schemes have increasingly been seen in many low-and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004. Several peer review studies and other research reports have since assessed the performance of the scheme with positive rating while challenges also noted. This paper contributes to the literature on economic and political implementation challenges based on empirical evidence from the perspectives of the different category of actors and institutions involved in the process. Methods: Qualitative in-depth interviews were held with 33 different category of participants in four selected district mutual health insurance schemes in Southern (two) and Northern (two) Ghana. This was to ascertain their views regarding the main challenges in the implementation process. The participants were selected through purposeful sampling, stakeholder mapping, and snowballing. Data was analysed using thematic grouping procedure. Results: Participants identified political issues of over politicisation and political interference as main challenges. The main economic issues participants identified included low premiums or contributions; broad exemptions, poor gatekeeper enforcement system; and culture of curative and hospital-centric care. Conclusion:The study establishes that political and economic factors have influenced the implementation process and the degree to which the policy has been implemented as intended. Thus, we conclude that there is a synergy between implementation and politics; and achieving UHC under the NHIS requires political stewardship. Political leadership has the responsibility to build trust and confidence in the system by providing the necessary resources and backing with minimal interference in the operations. For sustainability of the scheme, authorities need to review the exemption policy, rate of contributions, especially, from informal sector employees and recruitment criteria of scheme workers, explore additional sources of funding and re-examine training needs of employees to strengthen their competences among others. Implications for policy makers • Within the context of this study, addressing the political and economic challenges of the national health insurance schemes (NHIS) in Ghana requires a policy review of the exemption policy to make it more target-specific. This has the potential of ensuring those who really cannot afford get services. • Contributions from both formal and informal sector employees also need to be marginally adjusted upward including the introduction of some percentage of taxes on alcohol and tobacco product...

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Section: Summary Of the Main Elements Of Ghana's National Health Insumentioning

confidence: 99%

The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation

Fusheini

2016

Int J Health Policy Manag

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“…Similarly, Courbage et al (2004) find that life style habits such as smoking and exercise activities are not affected by private health insurance take-up amongst British households. Mensah et al (2010) find in Ghana that health insurance increased pre-and post-natal preventive visits, seeming to indicate that insurance enrollment is associated with an increased awareness of health risks and prevention. The insurance has a positive effect on private behavior to decrease the probability of health risks related to pregnancy.…”

Section: Health Insurance and Attitudes Towards Health Risks: Ex-antementioning

confidence: 87%

Health Insurance and Health Environment: India's Subsidized Health Insurance in a Context of Limited Water and Sanitation Services

McBain

2014

SSRN Journal

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractRecently, many emerging countries have established subsidized health insurance schemes to provide financial protection and support access to health care to poor households. The challenge to ensure the long term sustainability of such schemes is huge. In this paper, the impact of the health environment on the long term sustainability of a health insurance is explored, focusing on water and sanitation. India offers an interesting case to explore this question. Indeed, since 2008 India launched a fully subsidized health insurance Rashtriya Swasthya Bima Yojana (RSBY) in a context where 56% of its population does not have access to safe sanitation and 8% do not have access to safe water (JMP, 2012). A framework is proposed linking water supply and sanitation; health status of the insured population; health insurance and the productivity of households. Next, based on a literature review, the outcomes of investments in water and sanitation and health insurance are reviewed and the potential synergies and trade-offs of combing these investments are explored. In a last section, the case of India is analysed in detail, with international comparisons and further research lines are proposed.

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“…8 That is, the matching approaches lead to subsamples of treated and control facilities that are balanced with respect to the observables, whereas there are substantial differences in the covariates for the unmatched subsamples. These results ensure that we are comparing facilities with similar characteristics in our matching analysis (Mensah et al 2010). For EMS certification, though, Tables A4 and A5 show that neither covariate-, nor propensity-score matching lead to a balancing in all covariates.…”

mentioning

confidence: 80%

Environmental Management Systems Does Certification Pay?

Krätschell

Zwick

2014

SSRN Journal

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Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching

Cited by 194 publications

References 17 publications

The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation

The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation

Health Insurance and Health Environment: India's Subsidized Health Insurance in a Context of Limited Water and Sanitation Services

Environmental Management Systems Does Certification Pay?

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