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In 2003 the Government of Ghana established a National Health Insurance Scheme (NHIS) to improve health care access for Ghanaians and eventually replace the cash and-carry system. This study evaluates the NHIS to determine whether it is fulfilling its purpose in the context of the Millennium Development Goals #4 and #5 which deal with the health of women and children. We use Propensity Score Matching techniques to balance the relevant background characteristics in our survey data and compare health outcomes of recent mothers who are enrolled in the NHIS with those who are not. Our findings suggest that NHIS women are more likely to receive prenatal care, deliver at a hospital, have their deliveries attended by trained health professionals, and experience less birth complications. We conclude that NHIS is an effective tool for increasing health care access, and improving health outcomes.
This volume analyzes Ghana s National Health Insurance Scheme and highlights the range of policy options needed to assure its financially sustainable transition to universal coverage.
Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.
This fascinating collection shines a social epidemiological spotlight on the key public health issues affecting sub-Saharan Africa today. Beginning with the legacy of colonial rule, this book outlines the complex interplay between population health and a range of social, economic, and cultural factors. It shows how social epidemiological methods can offer a deeper understanding of population health and features chapters on a range of infectious diseases that continue to have a devastating impact on the region, including Sickle Cell Disease, HIV/AIDS, Leprosy, and Ebola. The final section of this book includes a series of case studies in which social epidemiological methods have been used to explore specific public health issues. Providing a timely overview of the relationship between social systems and human biology in the region, this important book will interest students and researchers across Public Health, Medicine, and African Studies.
This book is the first compilation of its kind that brings together discussions of the evolution of scholarship in different branches of the Social Sciences. It presents a comprehensive multi-disciplinary text exploring the changing dynamics of the Social Sciences in Ghana, offering a broader perspective from which to view the evolution, theory, methods, substance and relevance of each of the Social Science disciplines and their multiple interfaces. The introduction and the conclusion are devoted to the theoretical, comparative and empirical debate over the Social Sciences from historical and analytical perspectives. Written by acknowledged experts, the 15 chapters span the following disciplines: Archaeology and Heritage Studies; History; Geography; Psychology; Sociology and Anthropology; Social Work; Economics; Political Science; International Affairs; Information Studies; Communication Studies; African Studies; Development Studies; Women’s and Gender Studies and Adult and Continuing Education. Changing Perspectives on the Social Sciences in Ghana offers sophisticated perspectives for comparing and appreciating the synergies, differences, trends and nuances among and between the Social Science disciplines in Ghana, in a holistic and scholarly manner.
Access to and use of health services are concerns in poor countries. If implemented correctly, health insurance may help solve these concerns. Due to selection and omitted variable bias, however, it is difficult to determine whether joining an insurance scheme improves medical care–seeking behaviors. This paper uses representative data for the whole country of Ghana and an instrumental variable approach to estimate the causal impact on healthcare use of participating in Ghana’s National Health Insurance Scheme. Idiosyncratic variations in membership rules at the district level provide exogenous variation in enrollment. The instrument is the existence of nonstandard verification methods to allow enrollment of children. Using the 2008 Ghana Demographic and Health Survey and a census of all district insurance offices, this paper finds that insurance membership increases the probability of (1) seeking higher-quality (but no greater quantity of) maternal services and (2) parents’ becoming more active users of child curative care. Instrumental variable estimates are larger than ordinary least squares ones, indicating that “compliers” have much higher returns to being insured than the average participant. Results are robust to several validity checks; this paper shows that the instrument is indeed idiosyncratic and proves that government officials did not establish less-cumbersome membership rules in districts with worse initial indicators.
The geographies of health and development is an emerging sub-discipline, tying in with many of the conceptual, theoretical and practical components of other disciplines working in health, health care, economics, and international development. Spatially and theoretically grounded in geography, this collection offers a fresh perspective on the dialectic relationships between health and development. Health problems in a developing context take on much higher rates of prevalence as a result of the varied cultural, structural and economic vulnerabilities of the people they impact. This book begins by exploring some of the circumstances surrounding the distinctive health inequities currently facing many developing countries, including malaria, maternal mortality and HIV/AIDS. This is followed by a discussion of how matters of physical access and human resource issues and, perhaps most importantly, the challenges of financing, together shape the access and utilization of health care. Examining how the environment interacts to influence the health of the people that live there, the next section includes discussion around challenges of food (in)security, and the importance of clean and uncontaminated water for health. Finally, the book explores the influence of globalization on health, specifically within the urban environment, against the backdrop of global health policy.
Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.
Health insurance is the mechanism used to respond to uncertainty and risk aversion to illness. Health insurance, whether private, public, or mixed, serves as the main structural foundation for health systems across countries. Its objectives are to minimize the financial burden of medical expenses on people and to enhance population health. Globally, there is a great diversity of health systems and even greater variation among them. There are substantial differences in health systems and health insurance between low- and middle-income nations. The primary explanation for this could be the disparities in the resources available to fund the health system. High-income countries have the financing ability to fund the provision of health care, whereas low- and medium-income countries have a harder time funding health care. Another challenge health systems face nowadays is the achievement of the United Nations Sustainable Development Goal 3: healthy lives and promoting well-being for all. To create resilient and sustainable health systems that guarantee healthy lives and foster well-being for people of all ages, many countries are redesigning their healthcare systems by improving financing, access, and coverage. This book discusses these issues in different health systems around the world, in low-, middle-, and high-income countries.
Politics & the Struggle for Democracy in Ghana is a pioneering attempt to describe the Ghanaian political system, define its parameters, its structures and analyze the ups and downs of democratic transitions and the struggles thereof. The book is a good fit for students pursuing courses in political science at the university level in Ghana or studying social science at Ghanaian Senior High Schools.