SEATTLE, Washington — Ghana is currently working toward universal healthcare and has made significant improvements in health coverage over the past 14 years. However, the quality and availability of care are often still lacking, an issue the government is working to solve. The government is takings steps to improve the quality and affordability of healthcare in Ghana.
In 2005, Ghana developed the National Health Insurance Scheme (NHIS) to provide health insurance to its vulnerable populations. The Minister of Health, Mr. Kwaku Agyeman Manu, is an advocate for universal health coverage, believing that health services should be accessible and affordable for all. Since then, the NHIS has grown from 1.3 million to 11 million members, now covering 38 percent of Ghana’s population.
While this growth is significant, it raises questions about why affordable government health insurance is not something more Ghanaians are taking advantage of. In general, the quality of healthcare in Ghana needs improvement. Healthcare infrastructure is less available in rural areas where traditional African medicine is still used by many who cannot afford to travel long distances for healthcare. Other religious institutions, both Christian and Muslim, also operate in rural areas.
Public hospitals in Ghana tend to be overcrowded and provide low-quality care while private facilities usually have better resources, but tend to be more expensive and are more often located in urban areas. A majority of hospitals only offer general services, lacking health professionals who can provide specialized treatments and services, including surgery.
While advancements such as this one are undoubtedly essential to improving the quality of healthcare in Ghana, a study in 2018 may have identified why enrollment in NHIS is so low and how improving quality of care and insurance coverage must be done in conjunction with one another. This study surveyed 1,903 households in Ghana about their perceptions of healthcare quality based on experiences they’d had in the healthcare facilities.
Most respondents reported that healthcare quality is low; however, uninsured Ghanaians rated the quality higher than insured Ghanaians. An explanation for this disparity in perceptions about the quality of healthcare is posited by the researchers in the study. They argue that, under the NHIS, patients perceive the quality of their healthcare as lower because the healthcare delivery process is different based on how it is being paid.
Insured VS Uninsured Patients
For those who are uninsured, the only requirement for receiving care is the payment. This makes the delivery of healthcare services much quicker. Additionally, the uninsured can receive any kind of medication or treatment as long as they can pay for it. They have the option of paying cash for branded drugs and more specialized treatments.
In contrast, for insured patients, the healthcare providers have to process claim forms for consultation, diagnosis and drugs. This increases the waiting time for insured patients, who often spend hours waiting to receive healthcare. During this wait, they watch the uninsured go in and out, receiving care with a fraction of the waiting time. Furthermore, NHIS also does not cover all treatments, which can result in a lower quality of care for insured patients. NHIS also only covers generic drugs purchased outside of the healthcare facilities, which make them more difficult to obtain.
Therefore, the insured people experience delays in care, receive generic drugs and are sometimes unable to receive certain treatments. This fuels the perception that the uninsured are receiving higher quality care than those who are insured receive. Those who continue to enroll in the NHIS may be so financially burdened that they have no other choice but to have public health insurance. Those who can afford out-of-pocket costs may elect to do so instead because they see this as a higher quality option.
Fixing the System
However, achieving universal health coverage in Ghana will also require overcoming the idea that the quality of service is better for the uninsured. Specifically, the researchers recommend they consider “redesigning, reorganizing, and reengineering the NHIS” to process claims more efficiently and make branded drugs and more treatments available for insured patients.
Healthcare in Ghana has significantly improved over the last decade and a half, but more needs to be done to both improve the NHIS and increase the availability of facilities and the quality of the care offered. Continued initiatives by GE Healthcare will likely be beneficial, as will a direct response by the Ministry of Health to make the NHIS more desirable to Ghanaians.
– Sara Olk