Sustainability of the National Health Insurance Scheme: Views of Health Care Providers in the Cape Coast Metropolis, Ghana

Abstract

A National Health Insurance Scheme was introduced in Ghana in 2005 as part of strategies to ensure a sustainable health financing and improve access to services. After almost ten years of implementation, little is known about the views of health care providers as a major stakeholder on the critical experiences of health care providers on the implementation and sustainability of the National Health Insurance Scheme. It adopted in-depth interviews, observations and documentary review as methods of data collection. Forty health care providers working in 19 governments, private, quasi-government and mission health facilities in the Cape Coast metropolis were interviewed. Data from the interviews were analyzed using the Nvivo 7 software and by content analysis. There is a broad acknowledgement of the scheme as a propoor policy which has made a positive impact on access to health care. The involvement of front line health care providers in the policy formulation and processes was however, minimal. The sustainability of the scheme is largely threatened by the delayed and erratic reimbursement of claims and the unprofessional behaviour of providers and scheme managers. The proposed one-time premium payment policy can negatively affect the scheme. To for prompt reimbursement of claims, regular dialogue among stakeholders, explore additional funding sources and promote greater efficiency in the management of the scheme.