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Health Economics Review

, 2:13

First Online: 23 July 2012Received: 07 February 2012Accepted: 28 June 2012DOI: 10.1186-2191-1991-2-13

Cite this article as: Dalinjong, P.A. & Laar, A.S. Health Econ Rev 2012 2: 13. doi:10.1186-2191-1991-2-13


BackgroundPrepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme NHIS to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behavior of health care providers in their treatment of insured and uninsured clients.

MethodsThe study took place in Bolgatanga urban and Builsa rural districts in Ghana. Data was collected through exit survey with 200 insured and uninsured clients, 15 in-depth interviews with health care providers and health insurance managers, and 8 focus group discussions with insured and uninsured community members.

ResultsThe NHIS promoted access for insured and mobilized revenue for health care providers. Both insured and uninsured were satisfied with care survey finding. However, increased utilization of health care services by the insured leading to increased workloads for providers influenced their behavior towards the insured. Most of the insured perceived and experienced long waiting times, verbal abuse, not being physically examined and discrimination in favor of the affluent and uninsured. The insured attributed their experience to the fact that they were not making immediate payments for services. A core challenge of the NHIS was a delay in reimbursement which affected the operations of health facilities and hence influenced providers’ behavior as well. Providers preferred clients who would make instant payments for health care services. Few of the uninsured were utilizing health facilities and visit only in critical conditions. This is due to the increased cost of health care services under the NHIS.

ConclusionThe perceived opportunistic behavior of the insured by providers was responsible for the difference in the behavior of providers favoring the uninsured. Besides, the delay in reimbursement also accounted for providers’ negative attitude towards the insured. There is urgent need to address these issues in order to promote confidence in the NHIS, as well as its sustainability for the achievement of universal coverage.

KeywordsNational health insurance Social health insurance Universal health coverage Perceptions Experiences Health care providers’ behavior Insured Uninsured Ghana AbbreviationsCBHISCommunity-based Health Insurance Schemes

DMHISDistrict mutual health insurance schemes

FGDsFocus group discussions

GDRGsGhana diagnostic related groupings

NHINational health insurance

NHIANational health insurance authority

NHISNational health insurance scheme


SHISocial health insurance

SSNITSocial security and national insurance trust.

Electronic supplementary materialThe online version of this article doi:10.1186-2191-1991-2-13 contains supplementary material, which is available to authorized users.

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Autor: Philip Ayizem Dalinjong - Alexander Suuk Laar


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