National Health Insurance Scheme of Ejisu-Juaben and Matters Arising

Abstract

The Ejisu-Juaben Health Insurance Scheme (EJHIS), a municipal health insurance scheme in the Asante Region, provides insurance cards to subscribers in the municipality to access affordable health care from accredited health facilities. The study was carried out to find out the extent to which health care is accessible and affordable to the people and to determine the sustainability of the scheme. Ten communities in the municipality were purposively selected. These communities cut across the entire municipality; these include both urban and rural settlements. The study adopted the descriptive survey design using the case study approach focusing on accessibility, affordability and sustainability of the health insurance scheme. In all 120 participants were selected for the study which includes managers, health service providers and subscribers comprising opinion leaders, community leaders and community members. Data was collected using semi-structured interview and interview guide. Responses were coded and analyzed. Findings showed that the government and the administrators at Ejisu-Juaben are committed to the implementation of health insurance policy and provide improved health care in the municipality. The study recommends a strong collaboration based on understanding among the scheme management, the health service providers and subscribers in Order to achieve a successful, affordable, accessible and sustainable health care. Scheme managers are urged to make the insurance more attractive, and create enhanced communication channels to promote transparency in their operations.

Epidemics and the Health of African Nations

“…Ghana is one of the few countries in Africa to have successfully implemented a form of social insurance health care, known locally as the National Health Insurance Scheme (Sarpong et al, 2010). Ghana's success rate stems from the zealous efforts made by previous governments to pursue universal health care for poor and vulnerable groups (see Adu-Gyamfi et al, 2015a). Political actors from Kwame Nkrumah, Kofi Busia, to John Kufuor all pushed for some form of health care financing based on the belief that health care implementation and financing is an essential tool for social and economic development.…”

“…Claims payments to providers were often delayed for a long time, thereby denying subscribers essential services, such as drug supply and medical care. In addition, inconsistent billing systems by providers, lack of effective mechanisms for tracking claims, and the low billing the scheme had introduced undermined the idea of equity in the Ghanaian health system (Adu-Gyamfi et al, 2015a).…”

“…Furthermore, some subscribers do not complete treatment at one health centre. This leads to a duplication of cost, which burdens the scheme financially (Adu-Gyamfi et al, 2015a). This moving from one centre of care to another might be attributed, in part, to how the subscriber was treated by health officials in their previous centre.…”

National Health Insurance Scheme and household welfare: Evidence from Ghana

“…Available studies have indicated the propensity of health insurance coverage to reduce the occurrence of catastrophic health expenditure (Baicker et al, 2013;Hu et al, 2016) and out-of-pocket health payments (Chua & Sommers, 2014;King et al, 2009) and engender utilisation of health services and health outcomes (Adu-Gyamfi et al, 2015;Adusi-Poku et al, 2015;Ameyaw et al, 2017;Bosomprah et al, 2015;Dzakpasu et al, 2012;Singh et al, 2015;Tilahun et al, 2018;Twum et al, 2018;Van Der Wielen et al, 2018;Wang et al, 2017;Yaya et al, 2019).…”

Sustaining Ghana’s National Health Insurance Scheme Through Preventive Healthcare Strategies and Legislation

“…The Authority, among others ensure equity in health care coverage, access by the poor to healthcare services, protection of the poor and vulnerable against financial risk, manage the National Health Insurance Fund, receive, process and pay claims for services rendered by healthcare providers, undertake programmes that further the sustainability of the National Health Insurance Scheme (NHIS) and generally oversees and reports on NHIS operations. AduGyamfi, Brenya and Amoah (2015) argue that people access the facilities rampantly even when they have gone for treatment and it is not time for them to go for review. They also allude to the multiple inflation of cost by health or medical facilities.…”