The National Health Insurance Scheme and Community Access to Healthcare;A Case Study of Abokobi

Abstract

Given the fact that health is indispensable element o f human development and effective functioning in society, there is always the demand for healthcare services. However, demand for healthcare services cannot be met if one does not have the means to finance the care needed. It has therefore been a matter o f necessity to find strategic means o f financing healthcare. One major strategy increasingly recognized as a tool to finance healthcare provision is health insurance scheme. This study seeks to investigate the relationship between health insurance scheme and financial access to healthcare for community members. In other words, the study attempts to find out how health insurance schemes remove financial barriers o f access to healthcare and protect community members in case o f illness against fluctuating health expenditures. The study looks at the National Health Insurance Scheme o f Ghana, with particular reference to the Ga District Mutual Health Insurance Scheme (GDMHIS) and its impact on financial access to healthcare for the members o f the community o f Abokobi in the Greater Accra Region. It employs qualitative and quantitative data collection methods to solicit information from the community members o f Abokobi and stakeholders o f health insurance and health providers to establish the relationship between health insurance and financial access to healthcare. The results of the literatures reviewed for this study indicate that health insurance removes the financial constraints posed by cash and carry system o f healthcare delivery, and puts insured community members in a higher capability to meet their healthcare needs. The literatures also reveal that though several factors like time, distance and transportation, geographical barriers and location o f health facilities influence access to healthcare, finance o f healthcare is the most serious factor that influences community m em bers’ access to healthcare. Though health facilities may be available, if a patient does not have money to pay for medical care, he/she will be denied access to care. The findings o f this study reveal that for insured community members the health insurance scheme removes financial barriers o f access to healthcare, whereas the non-insured still face serious financial barriers o f access to medical care. It also reveals that the educated salaried workers have access to health insurance whereas the least educated, unemployed, farmers, petty traders are mostly not insured and therefore face financial barriers o f access to healthcare. The study recommends strategic measures to be adopted to sustain the scheme and to improve community members’ access to healthcare. It also challenges further research into health insurance scheme for informal sector workers and rural population who lack social security" and since they are unable to accumulate money to get insured, still face serious financial barriers o f access to healthcare.