INTRODUCTION

1. IMPACT OF GHANA’S NATIONAL HEALTH INSURANCE SCHEME ON ACCESSIBILITY AND UTILIZATION OF HEALTH CARE: A CASE STUDY OF THE HO MUNICIPALITY By Agyemang, Seth and Afeawo, Godbless Kwame Nkrumah University of Science and Technology, Kumasi 2012 ANNUAL GGA/GGTA CONFERENCE KNUST, KUMASI 1-4 AUGUST, 2012

2. INTRODUCTION • Many households especially in developing countries are deprived of much health care because they cannot afford it. • It is also estimated that more than 100 million people globally are pushed into poverty each year because of astronomical health-care expenditures.

3. INTRO (CONT) • In Ghana, the introduction of hospital fees in 1985 and the cash and carry system in 1992 aimed at full recovery of cost of service laid a huge financial burden on especially the poor, and limited access to health care. • Viewed as harsh to the poor and vulnerable. • As a result many people died of common and treatable diseases. • NHIS was introduced under Act 650 of 2003 as a means of making healthcare affordable and accessible.

4. Intro (cont) • Forbes (1969) defines accessibility as implying the ease of getting to a place. Thus the ability to reach a facility from a defined location. • Phillips, (1990) draws distinctions between physical (potential) accessibility and revealed accessibility (utilisation). • One aim of Ghana’s NHIS is to eliminate the financial barrier to health care posed by the unpleasant full cost recovery system by limiting out-of-pocket cash payment at the point of service delivery. • Studies suggest that membership of health insurance schemes protected households from incurring high health expenditures (Osei-Akoto and Adamba, 2011; NDPC, 2009; Asante and Aitkins, 2008). • However, other studies suggest that membership of health insurance schemes may not increase health service utilisation or limit increases in out-of pocket payment for health expenditures (Gumber, 2001, Ekman, 2007, Chankova)

5. PROBLEM STATEMENT • Ghana has been contending with the problem of healthcare financing and accessibility over the years. • Upfront payment for health care at the point of service hugely limited access and utilisation. • Also led to reduction of resources available for the household. • Government established the NHIS with the aim of increasing access to health care and improving the utilisation of basic health care services for all citizens, especially the poor and vulnerable.

6. PROBLEM STATEMENT • However, with NHIS concerns have been raised about quality and availability of drugs, health coverage, delays in renewals of health insurance cards, among others. • The Ho Municipal Health Insurance Scheme has been twice adjudged the best in the country in terms of service delivery and patronage (Volta Regional Health Report 2010). But the question is whether such an achievement actually reflects the situation on the ground.

7. Research objectives • The paper seeks to find out impact of NHIS on health care accessibility and utilization in the Ho Municipality. Specifically, it seeks find out: • Level of awareness of the NHIS • Level of enrollment/membership, • Health seeking behaviour, and • Perceptions of beneficiaries about the operation of the scheme.

9. MATERIALS AND METHODS • Research Design • The study is a descriptive, cross-sectional survey. • Sampling • A randomly selected sample of 120 household heads from six communities was used-SokodeGborgame, KlefeAchiatime, AbutiaAgorve, ZiaviDzogbe, TaklaGborgame and Ho township, with 20 respondents from each. • Face to face interview using structured questionnaire was used for the sample. • Structured interview was used to obtain additional information on operation of the scheme from five scheme managers and accredited healthcare providers • Secondary data on health statistics from annual Health Reports of the District. Data collection took place from February to May 2012.

10. Data Collection • Survey-face to face interview using structured questionnaire. • Structured questionnaire for scheme managers and accredited healthcare providers • Secondary data on health statistics obtained from the District’s annual health reports. • Data collection took place from February to May 2012. • Data analysed with SPSS v16 and Excel 2007. Modes included examination of frequencies and percentages. Use of tables and charts to depict the results.

11. Results and Discussion • All the respondents were aware of the existence of the NHIS. Most common source of information is the media-radio and TV (63.3%), followed by community gatherings (18.3%). • Out of the 120 respondents, 110 had registered with the Scheme, representing 91.7 %. • 90% of the 110 were active members.

12. Respondent’s reasons for joining the NHIS • Security and peace of mind in times of ill-health (48.3%), • Free access to medical care (29.2%) • Beneficiaries expect to be able to access and utilize healthcare without worry about financial burdens. • More than 14% still pay for health care How respondents finance their healthcare

13. Where respondents seek treatment when sick • All 3-48% • 2 out of 3 -22.5% • Only once -30% Rate of Utilisation of Hospital for the past three times of ill-health

14. Standard of care received at the hospital Quality of healthcare delivery • Good-89 • Very good-15 • Indicates that standard of care is generally good. • Confirms Frimpong, (2009) that over 60% of NHIS members are satisfied with the system.

15. Most beneficiaries finance healthcare via other means apart from NHIS: Only 12 (10.1%) respondents rely entirely on NHIS while 98 (89.1%) use other means to finance their healthcare in addition to NHIS: • Upfront payment for healthcare (50%), • Use of herbal medicine (24%) • Self medication (26%). Inability of the scheme to cover most health needs, low quality drugs, long waiting times, etc.

16. Other means of financing health-care Frequency of paying for drugs outside of the NHIS

17. Conclusion • Majority of enrollees finance their healthcare through the NHIS. Standard of care given to beneficiaries is generally good. • Overall, NHIS has made a positive impact on accessibility and utilization of health care in the Ho municipality. • The major reason for enrolling is to remove the burden of worry about financing health when sick, i.e., security and peace of mind in times of ill-health. • There is general satisfaction with the NHIS for making healthcare affordable and accessible. • However, quite a number of people still make financial contributions to health care through for example, regular purchase of drugs as well as by indulging in self-medication. These are major setbacks in accessing healthcare facilities. • Other complaints have been delays in issuance of identification cards for new registrants and renewals of old cards, serving as disincentive for membership.

18. Recommendations • Intensification of strategies to further scale up rate of enrollment. • Range of diseases covered by the scheme should be scaled up. • Waiting times at health care facilities should be reduced through: expansion of facilities, increased recruitment, and redistribution of health personnel to understaffed and overburdened areas. • More private providers should be accredited to cater for the increasing demand for healthcare. • NHIS administrators should establish scheme offices across the municipality to facilitate registration, renewal and ease of access to medical care.

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