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The effect of the National Health Insurance Scheme (NHIS) on health service delivery in mission facilities in Ghana: a retrospective study
Open accessAbstract
BACKGROUND: In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) to minimize out-of-pocket expenditure at the point of use of service. The implementation of the scheme was accompanied by increased access and use of health care services. Evidence suggests most health facilities are faced with management challenges in the delivery of services. The study aimed to assess the effect of the introduction of the NHIS on health service delivery in mission health facilities in Ghana. We conceptualised the effect of NHIS on facilities using service delivery indicators such as outpatient and inpatient turn out, estimation of general service readiness, revenue and expenditure, claims processing and availability of essential medicines. We collected data from 38 mission facilities, grouped into the three ecological zones; southern, middle and northern. Structured questionnaires and exit interviews were used to collect data for the periods 2003 and 2010. The data was analysed in SPSS and MS Excel. RESULTS: The facilities displayed high readiness to deliver services. There were significant increases in outpatient and inpatient attendance, revenue, expenditure and improved access to medicines. Generally, facilities reported increased readiness to deliver services. However, challenging issues around high rates of non-reimbursement of NHIS claims due to errors in claims processing, lack of feedback regarding errors, and lack of clarity on claims reporting procedures were reported. CONCLUSION: The implementation of the NHIS saw improvement and expansion of services resulting in benefits to the facilities as well as constraints. The constraints could be minimized if claims processing is improved at the facility level and delays in reimbursements also reduced.
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Lack of adequate supply of drugs on the National Health Insurance drug list in health facilities has a detrimental effect on quality-of-service delivery, including skilled delivery care.
“Lack of adequate supply of drugs on the National Health Insurance drug list in health facilities, have a detrimental effect on the quality-of-service delivery, including skilled delivery care [20,41].”
From A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis (2024) · cites this paper as [41]
The Discussion says essential medicines are core to service delivery and notes intermittent supplies and limited access in some facilities. The Results report non-availability of some essential medicines. Neither passage establishes an effect on skilled delivery care or identifies the medicines as those on the National Health Insurance drug list. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe funding of the free delivery care policy under the NHIS is affected, which to some extent threatens its sustainability.
“This affects the funding of the free delivery care policy under the NHIS thus to some extent threatens its sustainability [41].”
From A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis (2024) · cites this paper as [41]
The Discussion (page not provided) reports that NHIS reimbursements did not match mission facilities’ expenditure in the short run and that some claims went unreimbursed. This supports a general concern about NHIS-related funding, but the paper does not link those shortfalls to the free delivery care policy or assess that policy’s sustainability. (LLM, conf=0.82)
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Research works printed but not linked: 29
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Abredu, J., Dwumfour, C. K., Alipitio, B., Alordey, M., Dzomeku, V. M., & Witter, S. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002902 · Cited by 4
Metadata
- Authors
- Aryeetey, G. C., Nonvignon, J., Amissah, C., Buckle, G., & Aikins, M.
- Affiliations
- University of Ghana (GH)
- Corresponding author
- Aikins, Moses
- Venue
- Globalization and Health
- Published
- 2016-06-07
- Volume
- 12
- Issue
- 1
- Pages
- 32-32
- ISSN
- 1744-8603 (ISSN-L)
- PMC
- PMC4897862
- OpenAlex
- W2418112180
- Cited by
- 32
- References
- 0
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 5 · 2021: 4 · 2020: 5 · 2019: 4 · 2017: 1
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Globalization and Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Practices
- Keywords
- National Health Insurance Scheme, health insurance, health care delivery, out-of-pocket costs, claims management, reimbursement, service readiness, essential medicines availability, Ghana
- MeSH terms
- Cross-Sectional Studies, Delivery of Health Care, Ghana, Health Facilities, Humans, Religious Missions, National Health Programs, Retrospective Studies
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