Principal-agent problems in implementation of Ghana’s health insurance scheme

Kipo-Sunyehzi, Daniel Dramani

doi:10.12660/joscmv11n2p59-74

Cited by 7 publications

(7 citation statements)

References 15 publications

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“…On the other hand, health insurance managers/officials expect service providers' strict compliance with tariffs and the use of appropriate referrals to help deal with delays in the processing of claims and reimbursement. Other challenges on NHIS identified by some service providers include how to effectively deal with corruption and intense political influence (Andoh-Adjei et al, 2018;Kipo-Sunyehzi, 2018;Christmals and Aidam, 2020;Akweongo et al, 2021).…”

Section: Literature Review Implementation Of the Nhis And Implementers And Beneficiaries' Perspectives On Qualitymentioning

confidence: 99%

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

Kipo-Sunyehzi

2021

PAP

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PurposeThis paper aims to examine the factors that affect the quality of healthcare services in the implementation of the National Health Insurance Scheme (NHIS) at the local level in Ghana from the perspectives of health policy implementers and beneficiaries in public-private organisations.Design/methodology/approachThis paper has adopted a mixed research method with both qualitative and quantitative data, with in-depth interviews, document analysis and focus groups discussions. A total of 107 participants took part in the interviews and the questionnaire survey.FindingsThe study found that these factors greatly affect the quality of healthcare services from the implementers’ perspectives — referrals, effectiveness in monitoring, timeliness, efficiency, reimbursement, compliance with standard guidelines of Ghana Health Service (GHS) and accreditation process. For the beneficiaries, three healthcare services factors are important, including medical consultations, diagnostic services and the supply of drugs and medicines. Some other factors are found to be the least prioritized healthcare services, namely the issuance of prescription forms, verification of identification (ID) cards and staff attitude. However, the study found that implementers and beneficiaries exhibited a mixed reaction (perspectives) on accessing some healthcare services. In some healthcare services where the implementers perceived that beneficiaries have more access to such services, the beneficiaries think otherwise, an irony in the perspectives of the two actors.Originality/valueThis paper adds to the extant literature on the perspectives of policy implementers and beneficiaries on factors that affect the quality of healthcare services in general and specifically on the implementation of NHIS in Ghana with the public-private dimension.

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Section: Literature Review Implementation Of the Nhis And Implementers And Beneficiaries' Perspectives On Qualitymentioning

confidence: 99%

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

Kipo-Sunyehzi

2021

PAP

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“…The principal-agent theory looks at the relationship between a principal(s) and the agent(s). As this study's findings revealed a cordial relationship between the principals (regulators) and their agents (procurement entities) (Jensen and Meckling, 1976;Kipo-Sunyehzi, 2018;Hu et al, 2022).…”

Section: Discussionmentioning

confidence: 55%

“…Thus, the choice of principal-agent theory has relevance at both international and national levels as well as local levels. The principal(s) need to monitor the actions and performances of the agent to avoid possible cases of shirking duties (Elsig, 2011), avoid scenarios of "interest divergence" (Kipo-Sunyehzi, 2018) and deal with what Smith et al (2018) call "conflicting interests." It is assumed that the agent is more knowledgeable than the principal in the task that the agent is hired to perform; this makes it hard for the principal to deal with adverse selection, moral hazards and information asymmetry.…”

Section: Theoretical Lensmentioning

confidence: 99%

“…How such a relationship facilitated and/or inhibited the two countries’ efforts towards achieving VfM in procurement. The principal-agent theory looks at the relationship between a principal (the procurement regulatory authorities, the owner, or the decision maker) and an agent (a person or entity that is contracted, hired or asked to perform a task) on behalf of the principal (Jensen and Meckling, 1976; Kipo-Sunyehzi, 2018; Hu et al , 2022).…”

Section: Introductionmentioning

confidence: 99%

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Public procurement policies of Nigeria and Ghana: an analysis of the administrative challenges in achieving value for money

Kipo-Sunyehzi,

Abubakari,

Banchani

2024

JOPP

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Purpose This study aims to focus on public policy concerning the implementation of public procurement policies in Nigeria and Ghana toward achieving value for money in the procurement of goods, services and works. It specifically analyzes some major administrative challenges Nigeria and Ghana are faced with in the administration/implementation of public procurement policies toward achieving value for money. It looks at the relationship between the state (regulatory authorities) and substate (procurement entities) in the public sectors of Nigeria and Ghana. Design/methodology/approach A comparative case study approach is adopted, where the two countries are compared in terms of achieving value for money. Data was collected from multiple sources, including in-depth interviews. The use of official documents and direct observations at the procurement regulatory authorities and entities’ premises. Findings This study found Nigeria often used the four Es – economy, efficiency, effectiveness and equity while Ghana mainly used the traditional five rights (right quantity, right quality, right price, right place and right time) as their criteria for ensuring value for money. The major administrative challenges found include corruption, low capacity of procurement personnel and poor knowledge of the procurement laws. Social implications It recommends effective collaboration between government and civil society groups in the fight against corruption in procurement-related activities, with the implication that there is a need for periodic training for public procurement officials. Originality/value It adds to the field of public procurement in terms of value for money in the procurement of goods, services and works in developing countries context.

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“…Therefore, any activity that promotes awareness creation will invariably increase demand for services [10]. Usually, the enrollees do not have the information needed to determine the appropriate services they require and as a result they hand over the responsibility of these choices to a provider (agent) [11,12]. The knowledge of the agent may be imperfect and therefore may not advice the enrollee correctly on which services to take and on how to take it thereby resulting in poor demand for services.…”

Section: Introductionmentioning

confidence: 99%

Critical Determinants of Demand for Services in the Nigeria Formal Sector Social Health Insurance Programme

Vincent¹,

Lewechi²,

Iloh³

et al. 2020

HEP

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Introduction: Social health insurance programme was initiated in Nigeria with one of the aims being to improve the demand for quality healthcare services with a resultant reduction in catastrophic spending among the citizenry. Unfortunately, in this programme, healthcare providers who offer quality healthcare services still witness poor enrollee demand for services which has led to inability of the programme to achieve its set out objectives. Hence, the need to study the effects of selected critical determinants on demand for health insurance services and how much these determinants can collectively account for the demand for services in the programme. Design/Methodology: The study adopted a cross sectional design with a quantitative approach. The sample size was calculated using G-Power 3.1 software and the determined sample for the study was one thousand four hundred and thirty five (1435). Multistage sampling method was adopted. Data was analyzed using descriptive statistics and linear regression method with the aid of SPSS version 11. Result: The critical determinants of provider ownership, distance to healthcare provider, enrollee educational level have significant positive effect on the demand for health insurance services (<0.05) but the effect of enrollee income was positively insignificant (>0.05). Similarly, 75% of the changes in demand for health insurance services can be accounted for by the predictor variables in this study. Conclusion: The inability of the programme to address these selected critical determinants significantly will lead to out of pocket spending for healthcare services with a resultant catastrophic effect on families' finances. Therefore, there is a need to take into account the effects of these determinants duringpolicy formulation, reviews and process implementation in the programme.

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Principal-agent problems in implementation of Ghana’s health insurance scheme

Cited by 7 publications

References 15 publications

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

Public procurement policies of Nigeria and Ghana: an analysis of the administrative challenges in achieving value for money

Critical Determinants of Demand for Services in the Nigeria Formal Sector Social Health Insurance Programme

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