Challenges of Health Care Delivery at a Municipal Health Facility under Ghana’s National Health Insurance Scheme

Abstract

Introduction: Empirical evidence on challenges to health care delivery at district/municipal level under the National Health Insurance Scheme (NHIS) in Ghana is limited. This study determined challenges to optimal health care delivery at a municipal hospital under
Ghana’s NHIS.
Method: A cross-sectional study was undertaken between January-March 2010 at the Winneba Municipal Hospital (WHM) in Ghana to review out-patients (OPD) records from 2005- 2008. A structured questionnaire was used to collect data from 345 outpatients
(170 insured and 175 uninsured), and from their folders. Eleven key informants from the WMH were interviewed.
Results: The NHIS was introduced at the WMH in 2006, resulting in an increased OPD attendance of 77.3% in 2007. Insured clients visited the OPD many times and at shorter intervals than uninsured clients. Disease patterns at the OPD were however similar
before and after the introduction of NHIS at the Hospital. Key health providers at the WMH admitted to increasing OPD numbers and prolonged client waiting times. Over 40% of insured clients spent three hours or more to receive OPD services. Financial support from
the Government to the WMH has reduced since the introduction of NHIS. In 2008, over 70% of total hospital revenue was from the NHIS; delays in payment by District/Municipal Mutual Health Insurance Schemes (DMHIS) significantly strained hospital finances
and provision of drugs and supplies.
Conclusions: Increased OPD numbers, prolonged client waiting times, consumer moral hazard, limited Government financial support and delayed NHIS funds were critical challenges at the WMH. Innovative measures to limit moral hazard (i.e. reward mechanisms
for non-frequent visits, and introduction of copayments for multiple visits) are recommended. Means to improve the skills of hospital staff dealing with NHIS and staff of the DMHIS are policies worth pursuing.