Assessment of Quality of Healthcare in National Health Insurance Credentialed Hospitals in the Greater Accra Region

Abstract

Background Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to provide financial risk protection against the cost of basic quality care for residents. To ensure the achievement of high quality of healthcare, the National Health Insurance Authority (NHIA) credentialed health facilities are required to guarantee to provide services that will meet the satisfaction of the NHIS members. There have been wide reports of poor quality of care provided to insured clients in the National Health Insurance Scheme credentialed hospitals. Empirical data on quality of care in these hospitals as evidence for policy decision is limited and the factors contributing to poor quality in credentialed facilities are less explored. Objective Using Donabedian’s model of quality, this study evaluated the quality of healthcare in NHIS credentialed hospitals including government, private, and mission facilities for both insured and uninsured patients in the Greater Accra Region. Methods The study employed a cross sectional design using a mixed methods approach to collect data in selected hospitals (Public, Mission and Private). A multistage sampling technique was used. A simple random sampling method was applied to select the region while cluster sampling was used in selecting the hospitals. Purposive and convenient sampling methods were then applied in the selection of 630 patients and 250 health workers for the survey. The study reviewed medical records and administered structured questionnaires to survey participants and key informant interview for hospital in-charges. Results More than half (50.7%) of patients received good standard care with highest quality of care in private health hospitals and least in government hospitals. There was no difference in quality of care for both insured and uninsured patients in private hospitals However, the insured patients in mission hospitals reported that they received good quality of care compared with the uninsured, while in the government hospitals, the uninsured reported that they received good quality care. More than half (51.3%) of respondents (insured and uninsured) indicated that they were satisfied with quality of healthcare received in the hospitals. (63.5%) of the insured and (36.5%) of uninsured reported they were satisfied with the healthcare accessed. Regarding process quality, factors such patient confidentiality, staff attitudes, staff turnover, and prescribing restrictions had a significant impact on the standard of care provided in the credentialed facilities. Results on structures how those credentialed facilities have adequate human resources according to WHO's WISN scores but insufficient financial and infrastructure resources. Average waiting time of 31.13 minutes at the hospitals was close to Institute of Medicine (IOM) standard (30 minutes). Majority of patients (62.0%) received medicines prescribed. Conclusion The assessment of healthcare quality in NHIS-credentialed hospitals, using Donabedian's model which includes structure, process, and outcome, indicated that all three aspects of quality were well-maintained. Both patients and health workers reported satisfaction with the quality of healthcare, showing no significant difference in care based on health insurance status. This suggests that the quality of healthcare provided to both insured and uninsured patients was comparable. Moreover, the standard of treatment in these hospitals was found to be in line with the guidelines stipulated by health regulatory bodies. This alignment with treatment guidelines further supports the finding of good quality healthcare in NHIS-credentialed hospitals across government, private, and mission facilities in the Greater Accra Region. Recommendations To improve the quality of care in health facilities, it is essential to increase training and recruitment of health workers, particularly pharmacists and midwives. Ensuring regular funding to the NHIA for claims reimbursement and timely vetting and payment of healthcare provider claims is also critical. Additionally, intensifying membership drives and improving enrollment initiatives, such as mobile phone renewals and workplace renewals, can boost participation. Addressing out-of pocket payments for services and medicines covered by NHIS, with stakeholder collaboration, is necessary to sustain the scheme. Prompt claims payments to providers will ensure the availability of resources and enhance the quality of healthcare, addressing current issues caused by delays in reimbursements.