Abstract:
Background: In 2003, Ghana introduced the national
health insurance scheme (NHIS) to promote access to
healthcare. This study determines consumer and provider
factors which most influence the NHIS at a municipal
health facility in Ghana.
Method: This is an analytical cross-sectional study at
the Winneba Municipal Hospital (WHM) in Ghana
between January-March 2010. A total of 170 insured
and 175 uninsured out-patients were interviewed and
information extracted from their folders using a questionnaire.
Consumers were from both the urban and
rural areas of the municipality.
Results: The mean number of visits by insured consumers
to a health facility in previous six months was
2.48 +/- 1.007 and that for uninsured consumers was
1.18 +/- 0.387(p-value<0.001). Insured consumers visited
the health facility at significantly more frequent
intervals than uninsured consumers (χ2 = 55.413, pvalue<
0.001). Overall, insured consumers received
more different types of medications for similar disease
conditions and more laboratory tests per visit than the
uninsured. In treating malaria (commonest condition
seen), providers added multivitamins, haematinics,
vitamin C and intramuscular injections as additional
medications more for insured consumers than for uninsured
consumers.
Conclusion: Findings suggest consumer and provider
moral hazard may be two critical factors affecting the
NHIS in the Effutu Municipality. These have implications
for the optimal functioning of the NHIS and may
affect long-term sustainability of NHIS in the municipality.
Further studies to quantify financial/ economic
cost to NHIS arising from moral hazard, will be of immense
benefit to the optimal functioning of the NHIS.