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A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

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  • Robert Kaba Alhassan
  • Edward Nketiah-Amponsah
  • Daniel Kojo Arhinful

Abstract

Background: The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana. Methods: Electronic search was done for literature published between 2003–2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context. Results: Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients’ trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper. Conclusions: The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.

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  • Robert Kaba Alhassan & Edward Nketiah-Amponsah & Daniel Kojo Arhinful, 2016. "A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-16, November.
    • Handle: RePEc:plo:pone00:0165151
    DOI: 10.1371/journal.pone.0165151
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    1. Kwame Adjei-Mantey & Charles Yuji Horioka, 2023. "Determinants of health insurance enrollment and health expenditure in Ghana: an empirical analysis," Review of Economics of the Household, Springer, vol. 21(4), pages 1269-1288, December.
    2. Isaac Koomson & Abdallah Abdul-Mumuni & Anthony Abbam, 2021. "Effect of financial inclusion on out-of-pocket health expenditure: empirics from Ghana," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(9), pages 1411-1425, December.
    3. Maxwell Ayindenaba Dalaba & Paul Welaga & Abraham Oduro & Laata Latif Danchaka & Chieko Matsubara, 2018. "Cost of malaria treatment and health seeking behaviour of children under-five years in the Upper West Region of Ghana," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-14, April.
    4. Cherri Zhang & Md Shafiur Rahman & Md Mizanur Rahman & Alfred E Yawson & Kenji Shibuya, 2019. "Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-19, May.
    5. Hubert Amu & Kwamena Sekyi Dickson & Akwasi Kumi-Kyereme & Eugene Kofuor Maafo Darteh, 2018. "Understanding variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania: Evidence from demographic and health surveys," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-14, August.
    6. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    7. Indah Puspasari Kiay Demak & Diah Mutiarasari & Elli Yane Bangkele, 2019. "Does the Payment Method Affect Patient Satisfaction? An Analytical Study in 10 Hospitals in Central Sulawesi," Global Journal of Health Science, Canadian Center of Science and Education, vol. 11(5), pages 123-123, May.
    8. Helena Owusu & Pruthu Thekkur & Jacklyne Ashubwe-Jalemba & George Kwesi Hedidor & Oksana Corquaye & Asiwome Aggor & Allen Steele-Dadzie & Daniel Ankrah, 2022. "Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021," IJERPH, MDPI, vol. 19(19), pages 1-14, September.
    9. Hubert Amu & Abdul-Aziz Seidu & Ebenezer Agbaglo & Robert Kokou Dowou & Edward Kwabena Ameyaw & Bright Opoku Ahinkorah & Kwaku Kissah-Korsah, 2021. "Mixed effects analysis of factors associated with health insurance coverage among women in sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-15, March.
    10. Marion Ravit & Andrainolo Ravalihasy & Martine Audibert & Valery Ridde & Emmanuel Bonnet & Bertille Raffalli & Flore-Apolline Roy & Anais N’landu & Alexandre Dumont, 2020. "The impact of the obstetrical risk insurance scheme in Mauritania on maternal healthcare utilization: a propensity score matching analysis," Post-Print hal-02509190, HAL.
    11. Asuming, Patrick Opoku & Kim, Hyuncheol Bryant & Sim, Armand, 2017. "Long-Run Consequences of Health Insurance Promotion: Evidence from a Field Experiment in Ghana," IZA Discussion Papers 11117, Institute of Labor Economics (IZA).
    12. Patrick Opoku Asuming & Hyuncheol Bryant Kim & Armand Sim, 2021. "Selection and Behavioral Responses of Health Insurance Subsidies in the Long Run: Evidence from a Field Experiment in Ghana," Papers 2105.00617, arXiv.org.
    13. Raymond Elikplim Kofinti & Josephine Baako-Amponsah & Prince Danso, 2023. "Household National Health Insurance Subscription and Learning Outcomes of Poor Children in Ghana," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 16(1), pages 357-394, February.
    14. Patrick Asuming & Hyuncheol Bryant Kim & Armand Sim, 2018. "Long-run Consequences of Health Insurance Promotion When Mandates are Not Enforceable: Evidence from a Field Experiment in Ghana," Papers 1811.09004, arXiv.org, revised Jun 2019.
    15. Hamill, Heather & Hampshire, Kate & Mariwah, Simon & Amoako-Sakyi, Daniel & Kyei, Abigail & Castelli, Michele, 2019. "Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context," Social Science & Medicine, Elsevier, vol. 234(C), pages 1-1.
    16. Martin Amogre Ayanore & Milena Pavlova & Nuworza Kugbey & Adam Fusheini & John Tetteh & Augustine Adoliba Ayanore & James Akazili & Philip Baba Adongo & Wim Groot, 2019. "Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana," Health Economics Review, Springer, vol. 9(1), pages 1-15, December.

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