CHAPTER ONE

INTRODUCTION

1.0 BACKGROUND:

Health is the state of being or condition of the human life which is said to be very

vital. It is the dream of every government of a particular country to safeguard the life

of its citizenry, doing this may call for health policies formulated to make sure that

the citizens are healthy. This prompted the government of Ghana to institute the

National Health Insurance Scheme (NHIS) into the country to help do away with the

many problems associated with the cash-and-carry system by the Ex-President John

Agyekum Kuffour in 2003.

National health insurance scheme sometimes called statutory health insurance was a

health insurance that insured a national population for the cost of health care and

usually was instituted as a program of health care reform. It is enforceable by the law

court and administered by the private sector or public sector or even combination of

the two. The process of its functioning varied with a particular program and country.

Germany was the first country in the world to introduce the national health insurance

scheme to provide easy and affordable health care facilities to its citizens. National

health insurance in Ghana was established under the Act 650 of 2003 by the

government of Ghana to provide basic health care services to persons resident in the

country through mutual and private health insurance schemes, the districts mutual,

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private mutual and commercial schemes regulated by the National Health Insurance

Council (NHIC).The National Health Insurance Scheme (NHIS) is financed by:

1. Social Security and National Insurance Trust (SSNIT) 2.5%

2. Premium from subscribers.

3. National health insurance levy (NHIL) 2.5%. These are deductions from the

formal sector.

4. Funds from the government of Ghana (GOG), allocated by parliament.

5. Returns from investment.

The inception of the national health insurance in Ghana was very difficult. However a

more prudent national health insurance scheme was introduced in 2004. The

implementation of the health insurance scheme has effectively been underway since

2005, with particular intensive activities to enroll members since 2006. About 21% of

Ghanaians were insured and insurance cards were made available to them as at the

beginning of 2007, with further 16% awaiting entitlements of their cards.

Even though the implementation of the scheme was very difficult and expensive as

the ministry of health forecasted that it would require government a cash outlay of 70-

120 billion old cedi to be able to transform the cash-and-carry system to the current

national health insurance scheme, its implementation was very necessary and

beneficial to the country as it aided registered people to get health care even at the

times they could not afford to pay for health care should it be the cash- and-carry

system.

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1.1 METHODOLOGY:

The research is going to comprise both primary and secondary sources of obtaining

data through, interviews, questionnaires, newspapers, and the internet

These research methodologies were chosen because the researchers think they can

provide them the required information to aid their study. Also because the subscribers

have felt the benefits in one way or the other and will be able to attest to the benefits

derived from the national health insurance scheme.

1.2 STATEMENT OF THE PROBLEM:

National Health Insurance is popular in Ghana and its benefits are known mostly by

citizens, but some Ghanaians do not subscribe to the National Health Insurance

Scheme due to;

1) In adequate education about how the insurance works

2) Limited resources for its administration of the NHIS

3) Ineffective utilization of the resources available to health facilities to upgrade

the national health insurance scheme.

The above uncertainties necessitate this study into assessing the benefits of the

national health insurance scheme in the Tamale metro to enable more Ghanaians to

subscribe to it.

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1.3 PURPOSE OF THE STUDY:

The rational behind this study is to;

1) Help know the contribution made by various categories of persons under the

scheme.

2) Identify the various programs put in place that are advantageous to its

subscribers.

3) Know how the National Health Insurance Scheme is beneficial over the cash-

and –carry system.

4) Know how private hospitals are financed by government when National

Health Insurance is introduced in private hospitals.

5) Identify the sources of funding of the National Health Insurance Scheme.

1.4 RESEARCH QUESTIONS:

To be able to achieve these research objectives, the following research questions must

be answered

1) What is national health insurance scheme?

2) What constitute the sources of funds to the national health insurance scheme?

3) How does one become a beneficiary of the scheme?

4) How can registration and renewal of insurance cards be made convenient?

5) How can somebody above 18 years benefit from the scheme?

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6) Are the indigent covered under the national health insurance scheme?

7) What employment opportunities has national health insurance scheme created

since its inception?

8) To what extent has the national health insurance scheme solved the problem

of the cash-and –carry system.

1.5 SIGNIFICANCE OF THE STUDY:

The study will go a long way to;

1) Educate the general public on the benefits associated with the National Health

Insurance in Sunyani municipality.

2) Recommend to management as to the ways subscribers should be treated at the

various hospitals that will be of benefit to the subscribers.

1.6 OBJECTIVES OF THE STUDY:

The National Health Insurance Scheme has come up as a way through which

healthcare programmes can be undertaken in order to minimize the cash and carry

cost on the poor. The motive behind this study is to:

1) Find out into detail the benefits associated with the national health insurance

over the cash and carry system.

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2) To know the challenges individuals/subscribers face in their participation in

the national health insurance scheme.

1.7 CHAPTER ANALYSIS:

This is a study into the benefits associated with the national health insurance to the

country. Chapter one deals with the background of the study, statement of the

problem, purpose of the study, research questions, objectives of the study,

significance, methodology, limitations and an overview.

Chapter two concerns review of literature that is, theoretical and empirical review.

Chapter three is titled methodology and deals with population, sample and sampling

procedures.

Chapter four consist of the findings and analysis of data

Chapter five looks at the summary, conclusion and recommendations. And an

appendix will be included at the end of chapter five.

1.8 LIMITATIONS OF THE STUDY:

This research is to be limited to the Sunyani municipality because of insufficient time,

distance and financial constraints on the part of the researchers.

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CHAPTER TWO

LITERATURE REVIEW

2.0 INTRODUCTION

This chapter mainly concerns the review of literature relating to health, commencing

from the general historical background, other countries ideas about health, Ghana’s

government perception about health, and the mode of its function in the Sunyani

municipality coupled with definition of terms in relation to health insurance, the

common complaints about private health insurance, the mission and vision statement

as well as the complaints about publicly funded medicine.

2.1 HISTORICAL BACKGROUND OF HEALTH INSURANCE

A brief history of Health Insurance coverage reveals that in the aftermath of World

War II, the United States government sought to provide maximum health aids. This

policy continued for a number of years, until the introduction of relevant laws in 1950

to provide medical care for the needy populations of the state. The government of

Ghana took this as the first time to have participated in any form of financing health

care on behalf of the populations, and this was accomplished through direct payment

to the various health care-providers, doctors, physicians and hospitals. The United

State (US) government played a vital role in introducing health care insurance.

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The United State (US) also introduced the famous “medical assistance to the aged”

legislation in the 1960s, opening doors of medical assistance and other health care

services to the elderly and poor populations through putting restrictions on the extent

of medical expenses. This was followed by the passage of legislation for the

establishment of Medicare and medical programs’ in 1965 making a part of the Social

Security Act. Responsibilities of these programmes were entrusted to the department

of health, education and welfare, all of which are presently covered under a single

department of health and human services.

The Medicare programmes were however run by the Social Security Administration

while the Medicaid programs run by the Social and Rehabilitation Service. Both these

areas were then transferred to a newly formed Health Care Financing Administration

(HCFA) as of the year 1977 and renamed again as the Center for Medicare and

Medicaid Services (CMS).

In the U.S, Health Insurance is mostly in the hands of the private sector, however

there are two federal government health insurance programs known as Medicare and

Medicaid. These two programs are supported by the U.S federal government.

2.2 HEALTHCARE

In Ghana, most health care is provided by the government and largely administered

by the Ministry of Health and Ghana Health Services. The healthcare system has 5

levels of providers: health posts which are first level primary care for rural areas,

health centers and clinics, district hospitals, and regional hospitals. These institutions

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are funded by the government of Ghana financial credits, Internally Generated Fund

and a Donor Pool. Hospitals and clinics run by religious groups also play an

important role. There are 172 hospitals in Ghana. Hospitals run by religious groups

make up thirty-five percent (35%) of Ghana's health service provision. Collectively

they are known as the Christian Health Association of Ghana. Some for-profit clinics

exist, but they provide less than 2% of health services.

Health care varies throughout the country. Urban centers are well served, and contain

most hospitals, clinics, and pharmacies in the country. However, rural areas often

have no modern health care. Patients in these areas either rely on traditional African

medicine, or travel great distances for health care. In 2005, Ghana spent 6.2% of GDP

on health care, or US$30 per capita. Of that, approximately 34% was government

expenditure.

2.3 HISTORY

Traditionally, village priests and Muslim clerics were the primary care givers,

offering herbal remedies as well as spiritual healing. Though herbalists have

traditionally offered the most ready treatment of illness, pre-modern traditional

beliefs stressed the combination of spiritual and physical healing. Western medicine

was introduced by Christian missionaries to the Gold Coast in the nineteenth century,

and these were the sole medical providers until after World War I. After the war, the

central government made greater effort to expand western style medical facilities and

after World War II both the World Health Organization and the United Nations

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Children's Fund have been active in providing money and support to provide

additional western medical care in Ghana

2.4 NATIONAL HEALTH INSURANCE SCHEME

Until the establishment of the National Health Insurance Scheme, many people died

because they did not have money to pay for their health care needs when they were

taken ill. The system of health care which operated was known as the "Cash and

Carry” system. Under this system, the health need of an individual was only attended

to after initial payment for the service was provided. Even in cases when patients had

been brought into the hospital on emergencies it was required that money was paid at

every point of service delivery. When the country returned to democratic rule in

1992, its health care sector started seeing improvements in terms of:

1) Service delivery

2) Human resource improvement

3) Public education about health condition

Even with these initiatives in place many still could not have access to health care

services because of the cash and carry system.

The idea for the National Health Insurance Scheme (NHIS) in Ghana was conceived

by former President John Agyekum Kufour who when seeking the mandate of the

people of Ghana in 2000 elections, promised to abolish the “cash and carry system”

of health delivery Upon becoming president, former president Kufour pushed through

his idea of getting rid of the “cash and carry” system and replacing it with an

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equitable insurance scheme that ensured that treatment was provided first before

payment. In 2003, the scheme was passed into law. Under the law, there was the

establishment of National Health Insurance Authority which licenses, monitors and

regulates the operation of health insurance schemes in Ghana. Like many countries in

the world, Ghana's health insurance was fashioned out to meet specific needs of its

citizens, such as the need to attend hospital with no physical cash when taken ill.

Since the inception of National Health Insurance Scheme, the country's health

facilities have seen constant rise in patient numbers and a considerable reduction in

deaths.

2.5 DISEASES

According to the World Health Organization (WHO) the most common diseases in

Ghana include those which are endemic in sub-Saharan African countries,

particularly: cholera, typhoid, pulmonary tuberculosis, anthrax, whooping cough,

tetanus, chicken pox, yellow fever, measles, infectious hepatitis, trachoma, malaria.

Though not as common, other regularly treated diseases include dysentery, river

blindness or onchocerciasis, several kinds of pneumonia, dehydration, venereal

diseases, and poliomyelitis.

2.6 MATERNAL AND CHILD HEALTH CARE

In June 2011, the United Nations Population Fund released a report on The State of

the World's Midwifery. It contained new data on the midwifery workforce and

policies relating to newborn and maternal mortality for 58 countries. The 2010

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maternal mortality rate per 100,000 births for Ghana is 350. This is compared to

409.2 in 2008 and 549 in 1990. The less than 5 mortality rate, per 1,000 births is 72

and the neonatal mortality as a percentage of under 5's mortality is 39. The aim of this

report is to highlight ways in which the Millennium Development Goals can be

achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal

death. In Ghana the number of midwives per 1,000 live births is 5 and 1 in 66 shows

us the lifetime risk of death for pregnant women

2.7 PRIVATE HEALTH INSURANCE

Health insurance is one of the most controversial forms of insurance because of the

conflict between the need for the insurance company to remain solvent versus the

need of its customers to remain healthy, which many view as a basic human right.

This conflict exists in a liberal healthcare system because of the unpredictability of

how patients respond to medical treatment. Suppose a large number of customers of a

particular insurance company were to contract a rare disease costing 10 million

dollars to fight for each patient. The insurance company would be faced with the

choice of either charging all its future customers astronomical contributions (thus

losing customers and going out of business), paying all claims without complaint

(thus going out of business) or fighting the customers in an attempt to deny the costly

treatment (thus outraging patients and their families, and becoming a target for

lawsuits and legislation).

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There are further economic problems with private health insurance. Lack of

information about a person’s health and behavior is likely to lead to adverse selection

and moral hazard. In essence, those seeking health insurance are likely to be those

with existing medical problems or high likelihood of future medical problems and

those who take out insurance may engage in risky behavior, such as smoking and

excessive alcohol consumption, which they otherwise would not. These problems

may lead to 'good' insurance risks being priced out of the market or even insurance

being uneconomical to provide. With publicly funded health insurance the good and

the bad risks are all included in the coverage and the same moral hazard applies.

Further, every risk must subsidize the unhealthy, and those that take care of their

health have no opportunity to avoid this aid.

2.8 PUBLICLY FUNDED MEDICINE

Many countries have made the societal choice to avoid this important conflict by

nationalizing the health industry so that doctors, nurses, and other medical workers

become state employees, all funded by taxes; or setting up a national health insurance

plan that all citizens pay into with tax or quasi-tax payments, and which pays private

doctors for health care. These national health care systems also have their problems.

Some of these countries have citizen groups which protest bureaucracy and cost-

cutting measures that unduly delay medical treatment. Similar issues exist with

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private health management insurances (HMO) in countries with privately funded

medicine.

2.9 COMMON COMPLAINTS OF PRIVATE INSURANCE

Some common complaints about private health insurance include:

1) Insurance companies do not announce their health insurance premiums more

than a year in advance. This means that, if one becomes ill, he may find that his

premiums have greatly increased. This largely defeats the purpose of having

insurance in the eyes of many.

2) If insurance companies try to charge different people different amounts based on

their own personal health, people will feel they are unfairly treated. Some states

require that insurance companies cover all who apply at the same cost, or that

rates vary only by age of the insured; this rule has the effect (called adverse

selection) that healthy people subsidize sick ones, and thus frequently only those

in poor health buy insurance, making the premiums very expensive.

3) When a claim is made, particularly for a sizeable amount, it may be deemed in

the best interest of the insurance company to use paperwork and bureaucracy to

attempt to avoid payment of the claim or, at a minimum, greatly delay it. Some

percentage of insured’s will simply give up, leading to lower costs for the

insurance company.

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4) Health insurance is often only widely available at a reasonable cost through an

employer-sponsored group plan. This means that unemployed individuals and

self-employed individuals are at a disadvantage.

2.10 COMMON COMPLAINTS OF PUBLICLY FUNDED MEDICINE

Price no longer influences the allocation of resources, thus removing a natural self-

corrective mechanism for avoiding waste and inefficiency.

Health care workers' pay is often not related to quality or speed of care. Thus very

long waits can be had before care is received.

Because publicly funded medicine is a form of socialism, many of the general

concerns about socialism can be applied to this discussion.

United Kingdom

Healthcare in the United Kingdom

Each of the Countries of the United Kingdom has a National Health Service that

provides public healthcare to all UK permanent residents that is free at the point of

need and paid for from general taxation. However private healthcare companies are

free to operate alongside the public one. Since Health is a devolved matter,

considerable differences are developing between the systems in each of the countries.

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Africa

Countries that provide public healthcare in Africa are Algeria, Egypt, Ghana, Libya,

Mauritius Morocco, Seychelles South Africa, and Tunisia.

Funding models

Universal health care in most countries has been achieved by a mixed model of

funding. General taxation revenue is the primary source of funding, but in many

countries it is supplemented by specific levies (which may be charged to the

individual and/or an employer) or with the option of private payments (either direct or

via optional insurance) for services beyond that covered by the public system.

Almost all European systems are financed through a mix of public and private

contributions. The majority of universal health care systems are funded primarily by

tax revenue (e.g. Portugal Spain, Denmark and Sweden). Some nations, such as

Germany, France and Japan employ a multi-payer system in which health care is

funded by private and public contributions. However, much of the non-government

funding is by defined contributions by employers and employees to regulated non-

profit sickness funds. These contributions are compulsory and vary according to a

person's salary, and are effectively a form of hypothecated taxation.

A distinction is also made between municipal and national healthcare funding. For

example, one model is that the bulk of the healthcare is funded by the municipality,

specialty healthcare is provided and possibly funded by a larger entity, such as a

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municipal co-operation board or the state, and the medications are paid by a state

agency.

Universal health care systems are modestly redistributive. Progressivity of health care

financing has limited implications for overall income inequality.

Public

Some countries (notably the United Kingdom, Italy, Spain and the Nordic countries)

choose to fund health care directly from taxation alone. Other countries with

insurance-based systems effectively meet the cost of insuring those unable to insure

themselves via social security arrangements funded from taxation, either by directly

paying their medical bills or by paying for insurance premiums for those affected.

Compulsory insurance

This is usually enforced via legislation requiring residents to purchase insurance,

though sometimes, in effect, the government provides the insurance. Sometimes there

may be a choice of multiple public and private funds providing a standard service

(e.g. as in Germany) or sometimes just a single public fund (as in Canada). The U.S.

Patient Protection and Affordable Care Act is a law based on compulsory insurance.

In some European countries where there is private insurance and universal health

care, such as Germany, Belgium, and The Netherlands, the problem of adverse

selection (see Private insurance below) is overcome using a risk compensation pool to

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equalize, as far as possible, the risks between funds. Thus a fund with a

predominantly healthy, younger population has to pay into a compensation pool and a

fund with an older and predominantly less healthy population would receive funds

from the pool. In this way, sickness funds compete on price and there is no advantage

to eliminate people with higher risks because they are compensated for by means of

risk-adjusted capitation payments. Funds are not allowed to pick and choose their

policyholders or deny coverage, but then mainly compete on price and service. In

some countries the basic coverage level is set by the government and cannot be

modified.

Ireland at one time had a "community rating" system through VHI, effectively a

single-payer or common risk pool. The government later opened VHI to competition

but without a compensation pool. This resulted in foreign insurance companies

entering the Irish market and offering cheap health insurance to relatively healthy

segments of the market which then made higher profits at VHI's expense. The

government later re-introduced community rating through a pooling arrangement and

at least one main major insurance company, BUPA, then withdrew from the Irish

market

2.11 NATIONAL HEALTH INSURANCE SCHEME

Ghana is the first country in sub-Saharan Africa to have gained independence. From

March 6, 1957 when the British granted the country's independence, the country went

through several stages in its political journey. The country has suffered much from

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coups and bad governance. One area that suffered all through the turbulence was the

country's health system. The Ministry of Health through its numerous agencies is in

charge of the country's health care system. Until the establishment of the National

Health Insurance Scheme, many people died because they did not have money to pay

for their health care needs when they were taken ill. The system of health which

operated was known as the "Cash and Carry" system. Under this system, the health

need of an individual was only attended to after initial payment for the service was

made. Even in cases when patients had been brought into the hospital on emergencies

it was required that money was paid at every point of service delivery. When the

country returned to democratic rule in 1992, its health care sector started seeing

improvements in terms of:

1) Service delivery

2) Human resource improvement

3) Public education about health condition

Even with these initiatives in place many still could not access health care services

because of the cash and carry system.

2.12 ORIGIN OF GHANA'S NATIONAL HEALTH INSURANCE SCHEME

The idea for the National Health Insurance Scheme (NHIS) in Ghana was conceived

by former president John Kufour who when seeking the mandate of the people in the

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2000 elections, promised to abolish the “cash and carry system” of health delivery.

Upon becoming president, former president Kufour pushed through his idea of getting

rid of “cash and carry” and replacing it with an equitable insurance scheme that

ensured that treatment was provided first before payment. In 2003, the scheme was

passed into law. Under the law, there was the establishment of National Health

Insurance Authority which licenses, monitors and regulates the operation of health

insurance schemes in Ghana. Like many countries in the world, Ghana's health

insurance was fashioned out to meet specific needs of its citizens.

2.13 NHIS Policy

The health insurance was set up to allow everybody to make contributions into a fund

so that in the event of illness contributors could be supported by the fund to receive

affordable health care in our health facilities. Under this policy, three types of health

insurance schemes were set up. They were:

1) The District-Wide Mutual Health Insurance Scheme.

2) The Private Mutual Health Insurance Scheme.

3) The Private Commercial Health Insurance Scheme.

In order for the system to function well, the government decided to support the

District Mutual Health Insurance Scheme concept to ensure that:

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1) Opportunity is provided for all Ghanaians to have equal access to the

functional structures of health insurance.

2) Ghanaians do not move from an unaffordable ‘Cash and carry’ regime to

another unaffordable Health Insurance one.

3) A sustainable Health Insurance option is made available to all Ghanaians.

4) The quality of health care provision is not compromised under Health

Insurance.

2.14 Premiums

Like all insurance schemes, different types of premiums are available under the

country's NHIS. Contributors are grouped according to their levels of income. Based

on the group a contributor may fall in, there is specific premium that ought to be paid.

This was done since the socio-economic condition scheme contributors is not the

same and the contributions was to be affordable for all to ensure that nobody is forced

to remain in ‘cash and carry’ system. This meant that contributions payable could

vary from one district to the other as even the disease burden was also not the same in

all the districts. To ensure that all citizens made some contribution to the scheme, a

2.5% Health Insurance Levy on selected goods and services was passed into law so

that the money collected could be put into a National Health Insurance Fund to

subsidize fully paid contributions to the District Health Insurance Schemes.

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Nature of the scheme

In order to ensure the continuity of the scheme, two major lists were made. One had

all the conditions that the scheme could cover with the other have the excluded

conditions.

Diseases covered under the scheme

The Government came out with a minimum benefit package of diseases which every

district-wide scheme was to cover. This package covered about 95% of diseases in

Ghana. Diseases covered included among others:

Malaria

Diarrhoea

Upper respiratory tract infection

Skin Diseases

Hypertension

Diabetes

Asthma

However, all district-wide schemes were given the right under the law to organise

their schemes to cover as many diseases and services as they desire, provided it was

approved by the National Health Insurance Council.

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Exclusive list

Certain diseases were however excluded from the benefit package because it was

considered to be too expensive to treat. Therefore other arrangements had to be

considered to enable people get these diseases treated. Diseases currently not covered

are:

Optical aids

Hearing aids

Orthopaedic aids

Dentures

Beautification Surgery

Supply of AIDS drugs

treatment of Chronic Renal Failure

Heart and Brain surgery, etc.

All these constitute only 5% of the total number of diseases that Ghanaians suffered

from.

2.15 TYPES OF HEALTH INSURANCE

There are three main categories of health insurance in Ghana.

The first and most popular category is the district mutual health insurance scheme,

which is operational in every district in Ghana. This is the public/non-commercial

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scheme and anyone resident in Ghana can register under this scheme. If you register

in ‘District A’ and move to ‘District B’, you can transfer your insurance policy and

still be covered in the new district. The district mutual health insurance scheme also

covers people considered to be indigent – that is too poor, without a job and lacking

the basic necessities of life to be able to afford insurance premiums.

Apart from the premium paid by members, the district mutual health insurance

schemes receive regular funding from central government. This central government

funding is drawn from the national health insurance fund. Every Ghanaian worker

pays two-and-a-half percent of their social security contributions into this fund and

the VAT rate in Ghana also has a two-and-a-half percentage component that goes into

the fund.

To sign up for the district mutual health insurance scheme, you need to get to the

district assembly where you reside or look for the offices of the scheme and register.

You will fill a form, offering some basic personal information and you will be asked

to present at least two passport pictures. You will need to fill forms for dependants

above below 18 as well.

The second category of health insurance comprises the private commercial health

insurance schemes, operated by approved companies. You can just walk into any of

such companies and buy the insurance for yourself and dependants – just as you

would a car. Commercial health insurance companies do not receive subsidy from the

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National Health Insurance Fund and they are required to pay a security deposit before

they start operations.

The third category of health insurance is known as the private mutual health

insurance scheme. Under this, any group of people (say members of a church or

social group) can come together and start making contributions to cater for their

health needs, providing for services approved by the governing council of the scheme.

Private mutual health insurance schemes are not entitled to subsidy from the National

Health Insurance Fund.

2.16 BENEFITS OF HEALTH INSURANCE

If you register under any of the schemes, you will be given a card which you can use

to seek treatment in any hospital in the country. When you visit a health facility with

the card, you are treated and offered the services you have signed for without you

having to pay for anything – unless you ask for an extra service, like a private ward.

Your bills are then sent to your scheme provider (district, private scheme or mutual

scheme) which then pays the money to the hospital. You can also use your card to

buy prescribed drugs at accredited pharmacies or licensed chemical shops without

paying at the point of delivery – the pharmacy will contact your service provider to

take its money.

At least, that’s how the system is supposed to work on paper. But there have been

reports of some hospitals and pharmacies turning patients away, complaining that the

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public health insurance schemes owes them huge amounts of money. Some of the big

hospitals in the country have often been compelled to issue public statements warning

that their operations could grind to a halt if the Health Insurance Authority (NHIA)

doesn’t speed up the payment of their claims. The NHIA has assured that it is

working on these problems and in due course, they will be resolved.

Whatever form of health insurance you sign up to entitles you to some minimum

services. These are:

1) Out-patient services – general and specialist consultations reviews, general and

specialist diagnostic testing including, laboratory investigation, X-rays,

ultrasound scanning, medicines on the NHIS Medicines list, surgical operations

such as hernia repair and physiotherapy.

2) In-patient services – General and specialist in patient care, diagnostic tests,

medication-prescribed medicines on the NHIS medicines list, blood and blood

products, surgical operations, in patient physiotherapy, accommodation in the

general ward and feeding (where available).

2.17 MISSION STATEMENT

“To provide financial risk protection against the cost of quality basic heath care for all

residents in Ghana, and to delight our subscribers and stakeholders with an

enthusiastic, motivated and empathetic professional staff who share the values of

honesty, and accountability in partnership with all stakeholders” .

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2.18 VISION STATEMENT

Since the inception of National Health Insurance Scheme, it has been its dream to

“Be a model of a sustainable, progressive and equitable social health insurance

scheme in Africa and beyond”.

2.19 HEALTH

Health as defined by WHO constitution of 1948 is a state of complete physical, social

and mental well-being and not merely the absence of diseases or infirmity.

Health is a resource for everyday life, not the object of living. It is a positive concept

emphasizing social and physical resources as well as physical capabilities. In keeping

the concept of health as a fundamental right, the Ottawa charter emphasizes certain

pre-requisites for health which includes, peace, adequate economic resources, food

and shelter and stable economic system and sustainable resource use.

2.20 INSURANCE

Insurance is a promise of compensation for specific potential losses in exchange for a

periodic payment. Insurance is designed to protect a financial well being of the

individual, company or other entity, in the case of unexpected loss. Some forms of

insurance are required by law while others are optional. Agreeing to the terms of

insurance policy creates a contract between the insured and the insurer. In exchange

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for payment from the insured (premium) the insurer agrees to pay the policy holder a

sum of money upon the occurrence of a specific event.

Examples are car insurance, health insurance, disability insurance, life insurance and

business insurance.

Health insurance is a type of insurance whereby the insurer pays the medical costs of

the insured if the insured becomes sick due to covered causes, or due to accident. The

insurer may be a private organization or government agency. Market based health

care systems such as that used in the United States rely on private medical insurance.

2.21 DEFINITION OF TERMS

Insured person: means any person who pays the required contribution to the scheme

under the law.

Scheme: means the national health insurance scheme established under the law.

Organization: This is any health maintenance organization registered under the law

and includes institution, body corporate registered by the board to utilize its

administration by providing health care services through health care centers approved

by the board.

Health care

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This is the treatment and management of illness, and the preservation of health

through services offered by medical, dental, complementary and alternative medicine,

pharmaceutical, nursing and allied health professions. Health care embraces all the

goods and services designed to promote health.

Health care provider

Means a person or organization that provides services and or health care personnel to

deliver proper health care in a systematic way to individual in need of health care

services, a health-care provider could be government, the health care industry an

institution such as a hospital or medical laboratory.

29

CHAPTER THREE

METHODOLOGY

3.0 INTRODUCTION

This section outlines the methods used by the research team in obtaining data for the

purpose of the research. It also discusses what should be done, how it is to be done,

what data will be needed as well as data collection devices. This objective will be

achieved by identifying the sources of data, research design, sampling and sample

size, administering questionnaire, interviews, and the problems associated with the

data collection.

The researchers have decided to combine both interviews and questionnaire in order

to get a reliable and accurate data or information for the research work.

3.1 RESEARCH DESIGN

The research is purely a case study in the Sunyani Municipality to help assess the

benefits to subscribers of the National Health Insurance Scheme since its inception in

Ghana as well as the Sunyani Municipality of the Brong - Ahafo. The study area is

limited to the Sunyani Municipality.

3.2 POPULATION

The targeted population was the whole Sunyani Municipality but since the

Municipality is larger, full coverage of the entire population could not be reached due

to time and financial constraints. Hence only one Health Insurance office was chosen.

30

This covered the Manager, Accounts department, PRO, Claims department, MIS

department and some subscribers including students and those with no formal

education.

3.3 SAMPLING AND SAMPLE SIZE

Simple random sampling and probability sampling were used to select a sample from

the population for the study. The sample size comprised the scheme’s staff

(management), civil servants, and students in the Sunyani Municipality. The random

sampling was used to select respondents within the National Health Scheme’s office

for interview. To answer the questionnaire, persons under the coverage of the scheme

were given the questionnaire to administer as well as students and other respective

responses from the general community view.

The result from the research attested that, the questionnaire was clear and could be

understood by majority of the respondents. Interviews were also conducted to get

more and best information from the scheme’s staff of the area of case study. In

effect, both the questionnaire and the interviews were considered appropriate for the

topic under research over the sampling techniques.

3.3.1 QUESTIONNAIRE

The questionnaire was designed to find the various views and ideas about the scheme

and the scheme’s impact on the lives of people through those who subscribe which

include students and civil servants in the Sunyani community.

31

3.3.2 INTERVIEW

Interviews were conducted and various responses got from the Insurance Scheme’s

staff at the case study area were shown as it appears below.

. It was realized that registered members do not bring bills to the National Health

Insurance Scheme but rather the hospitals send their bills of the clients to be paid by

the Scheme.

Accordingly, the sources of funds also include the following;

1) The National Health Insurance Fund.

2) Allocation by parliament.

3) Internally generated fund.

4) 2.5% of Social Security contribution.

5) 2.5% of value added tax

Also, the National Health Insurance Scheme does not cover all sicknesses such as

abortions, plastic surgery but rather those that are covered by the medicine list which

is amended every year.

The study also revealed that, the position of the scheme was to get members

registered and pays their medical bills. The staff provided that, their role is to forecast

on their core mandate (that is ensuring that members are registered under the Scheme

and pay their bills for quality health care).

32

In addition were the functions of the various departments towards ensuring that

people get access to better Health Care.

Accounts department was responsible for all the financial transactions of the scheme,

PRO, for external relations, claims department for vetting of medical bills brought by

the hospitals and recommend to the accounts department for payment and

Management Information System department for the re instauration of the

computerized systems.

3.3.3 DATA ANALYSIS

The data will be analyzed into tables, bar charts, and simple percentages.

3.4 PROBLEMS OF DATA COLLECTION

The main problem faced was in respect of time and also the data gathering period

which coincided with the duties of officials and respondents.

33

CHAPTER FOUR

RESULTS OF THE STUDY

4.0 INTRODUCTION

This chapter presents the data and statistical analysis without discussing in detail the

implications of the study. This chapter is to critically assess the Sunyani

Municipality’s Health Insurance Scheme, one of the insurance schemes’ that has been

in operation for the past eight years. Also the performances of Sunyani Municipal

Health Insurance Scheme with regards to providing financial assess to health care for

subscribers, poor, utilization of services, the benefit packages of the scheme and the

future sustainability of the scheme will be examined.

4.1 OBJECTIVES

The objectives and motives behind this study are to;

1) Examine the position of the scheme in meeting the requirements of National

Health Insurance.

2) Examine the perception of the community concerning the scheme and whether

the people in the community have subscribed to the Scheme.

3) Examine the scheme’s ability to provide financial assess to health services by

the poor.

4) Examine the administrative cost of running the scheme.

34

5) Examine the scheme’s sustainability issues in terms of financial sustainability

(premium against cost of service, administrative cost and membership size).

4.2 METHODS OF ANALYSIS SUMMARY AND PRESENTATION OF

DATA.

The methods of data analysis, summary and presentation of data were in two fold

aspects which are shown below;

a. Instruments of data collection and

b. Procedure of sampling.

4.3 INSTRUMENTS OF DATA COLLECTION

The evaluation of the research has two main instruments for the collection of data

which are;

a. Interview about the scheme. Interview was conducted and completed by the

management of health insurance scheme. This interview covers the scheme’s

design, type of organizational structure in place, the scheme’s position in

meeting the health needs of its subscribers, general administration and

financial management issues, benefits associated with the scheme and its

sustainability as well as the scheme’s relationship with the health providers

within the Sunyani Municipality.

b. Questionnaire was also designed to collect information from respondents to

critically examine the Insured and Non-Insured in assessing health care within

35

the Sunyani Municipality. This questionnaire covered the

household/respondents characteristics, house wealth, membership issues,

financial access to health care and the perception of the community about the

scheme.

4.4 SAMPLING PROCEDURE

Due to the insufficient time frame and the financial constraints associated with the

study, implications of the whole coverage of all the insured a representative stratified

random sample of 20% of the insured under the health insurance scheme in the

Sunyani Municipality and the same percentage of Non-insured were considered. This

represents the internationally acceptable and recommended sample of 20% appropriate

for the study.

In addition, a persuadable pressure was instituted to enhance the validity and

reliability of the results from the respondents. It is also worth noting that, non

response due to either absenteeism or refusals which affects all social studies

hampered the achievement of the targeted sample size. However, in all cases efforts

were made to meet the 20% sample covering the entire Sunyani Municipality health

insurance scheme within the specified data collection area.

36

4.5 SOCIO-ECONOMIC CHARACTERISTICS OF THE SUNYANI

MUNICIPALITY

Sunyani is a city in the West African republic of Ghana, and is the capital of the

Brong-Ahafo Region.

According to the 2005 population estimates 80,245 people reside in the city of

Sunyani, with a growth rate, in the city, of 3.4% per annum.

History of Sunyani

Surrounded by the forested Southern Ashanti Uplands, the city of Sunyani arose as an

outpost camp for elephant hunters during the 19th century. The name Sunyani derives

from the Akan word for elephant 'Osono.' In 1924, The British colonial government

designated Sunyani as a district headquarters. Following the construction of a road

connecting Sunyani and the city of Kumasi, Sunyani became an important hub for the

distribution of cocoa, kola nuts, and staple foods such as maize and yams.

Trivia

Sunyani was voted the cleanest city in Ghana for the year 2007 by the Ghana Tourist

Board.

37

Education and Commerce in Sunyani

Today Sunyani is home to both the regional government and high court; the region's

post-secondary institutions are also based in the city; including two polytechnic

schools, the College of Renewable Natural Resources and the Catholic University.

Several of the country's best primary and secondary and technical schools can be

found within Sunyani and its suburbs, including: St. Mary's; Holy Spirit; Wesley's;

Divine; Ridge Primary; Twene Amanfo Secondary Technical School (TASTECH);

and Don Bosco Voc. Technical Institute. Attracting students from throughout the

region and beyond is the highly ranked Sunyani Senior High School (SUSEC) and St.

James seminary which have been rated among, the best five Senior High Schools in

Ghana.

Although considerably smaller than nearby Kumasi, Sunyani is growing rapidly and

has effectually engulfed the suburb towns of Fiapre and Abesim, amongst others.

Sunyani is a clean and well maintained city with a thriving economy.

The economy is predominantly agrarian with approximately 48% of the population

engaged in agriculture production. About 24 percent of the population is employed in

the service sector, followed by commerce and industry which employ 15% and 13%

of the populace, respectively.

The city’s growth is boosted by the city’s high-quality water supply. Water sources

include pipe borne water, bore holes, hand-dug wells, rain water and water from

38

streams, rivers and springs. However, in severe harmattan (dry) conditions, water can

become more difficult to access. Sunyani is provided with electricity by the Volta

River Authority.

The city has a number of financial institutions including a branch of the Bank of

Ghana, Ghana Commercial Bank, Fidelity Bank, Sahel Sahara Bank, Barclays Bank,

SG-SSB Bank, Agricultural Development Fidelity Bank, Sahel Sahara Bank ,Eco

Bank, the National Investment Bank etc. There are also six rural banks, a number of

credit unions and insurance institutions complementing the financial service provision

of the city.

The city also has three hospitals, one of which, Sunyani General Hospital, is a state-

of-the-art development, which opened in 2003. Eight clinics and three maternity

homes also operate in Sunyani.

Sister city

Sunyani, in partnership with nearby Techiman, currently has a sister city relationship

with Tuscaloosa Alabama in the United States.

4.6 HEALTH CARE FACILITIES IN THE SUNYANI MUNICIPALITY.

There are so many health facilities in the Sunyani Municipality. Some of these

facilities in the municipality are shown in the table below. These facilities are

classified into three levels of providing health services as level H facilities

(Hospitals), level C facilities (clinics) and level M facilities (maternity homes).

39

Table 4.1 indicating health care facilities in the Sunyani Municipality

Health care facilities Number of facilities Level of facilities

Hospitals 3 H

Clinics 8 C

Maternity Homes 3 M

Source: Field Research, 2012

Interpretations:

H=Hospitals

C=Clinics

M=Maternity homes

4.7 OPERATIONS OF THE SCHEME NATIONAL HEALTH INSURANCE

SCHEME

The year 2005 was described as a very busy year with both planned and unplanned

activities.

Among the planned activities programmed for the year 2005 were as follows:

1) To prepare all providers on their roles and responsibilities, on contract

signing and efficient claims administrations.

2) To train providers and all Ghana Health Service staff on implications of the

National Health Insurance Act650 and LI 1809.

3) To strengthen and to further equip the regional health insurance office

40

4) To monitor early problems of implementation

5) To continue to provide technical assistance to schemes.

ENROLMENT, UTILIZATION AND COST (SEPTEMBER – DECEMBER

2005):

Total Insured: 562,155

Total Premium collected: ¢13,060,153,953

Total Insured Outpatient attendance: 264,335

Total Insured Outpatient Cost: ¢12,235,795,338.63

Total Insured Admissions: 10,245

Total Insured Admission Cost: ¢4,899,910,576

Grand Total for Insured Attendance (Outpatient + Admission): 274,580

Grand Total for Insured Attendance Cost (Outpatient + Admission):

¢17,135,885,914.63.

The B/A region, has adopted Community Based Health Planning and Services

(CHPS) as strategy for reorienting and relocating primary healthcare from sub-district

health centers to convenient community locations (close to client).

It involves mobilization of grass root action and leadership for heath. CHPS will

reduce

Health inequalities and promote equity of health outcomes.

The number of these functional CHPS zones in the region increased from 4 as at

December 2004 to 14 as at the end of 2005 with the objectives;

41

1) To advocate for increase in numbers in the training of Community Health Nurses

2) To advocate for resources from District Assemblies and other development

partners for CHPS

3) To establish one Community Health Volunteer core at the CHPS zone level

4) To train stakeholders on collaboration for Health

5) Conduct technical skills training for 26 Community Health Organizations by end

of 2005.

CLINICAL/INSTITUTIONAL CARE

Outpatient Attendance

Outpatient attendance recorded during the year under review was, 1,487,680

which showed an increase of 10.2% over the same period in the year 2004

(1,350,504).

The increase of year 2004 over 2003 was 7.3%

There has been a gradual increase in attendance from 1999 to 2005

Table 4.2 Out Patient Department (OPD) attendance recorded during the period

2002 – 2005

Year Government Mission Private TOTAL

2002 698,611 (58.8%) 395,126 (33.3%) 94,021 (7.9%) 1,187,758

2003 703,300 (56.2%) 402,047 (32.1%) 146,135(11.7%) 1,251,482

2004 768,474 (56.9%) 386,637(28.6%) 195,393(14.5%) 1,350,504

2005 840,056 (56.5%) 435,519 (29.3%) 212,105(14.2%) 1,487,680

42

ADMISSIONS

Total admission recorded for the year under review was 77,798 which showed an

increase of 11.3% over 2004 (69,931).

Twenty (20) hospitals contributed to the inpatient attendance. These are categorized

as follows:

One (1) Regional Hospital

Seven (7) Government Hospitals

Ten (10) Mission Hospital

Table 4.3 contribution to inpatient attendance 2002-2004

Facility

Type

Year

2002 2003 2004 2005

Regional

Hospital

7,536

(12%)

7,817

(11.7%)

7,832 (11.2%) 8,371 (10.8%)

District

Hospitals

44,635

(71.4%)

48,763

(72.8%)

49,581

(70.9%)

68,052

(87.5%)

Other

Hospitals

10,429

(16.6%)

10,429

(15.5%)

12,518

(17.9%)

1,375 (1.8%)

Total 62,000 67,009 69,931 77,798

Source: Field Research, 2012

43

The Regional Hospital was established on 11th May 1927 by the then Colonial

Masters as a Hospital for the people of Western Ashanti. Since the establishment of

the hospital the population of Sunyani and, Brong Ahafo had increased more than 10

fold.

The Hospital had undergone a long transformation and expansion from the time

Brong Ahafo Region was calved out of the Ashanti Region 45 years ago. On the 4th

of August 2003 the hospital moved its services from the 79 years old facility into an

ultramodern hospital with the state of art medical equipment and diagnostic facilities.

MISSION

To provide quality driven, result oriented, customer centered and efficient healthcare

services in a well maintained environment by adequate number of well motivated,

competent and contended workforce which respect and value clients.

GOALS

1) To train the required human resource for the Hospital and the Country.

2) To provide enough suitable Staff accommodation for newly recruited Staff.

3) To improve the financial base of the Hospital to meet the huge PPM, and

recurrent expenses.

4) To motivate staff to improve on performance and attract new ones.

44

5) To institute structured In-Service Training for all Staff to upgrade their

knowledge and skills in modern practice of medicine.

VALUES

1) To be customer focused and results oriented

2) Employees are the greatest assets

3) Well maintained environment and equipments

4) Continuously enhance Staff professionalism

The hospital management comprises the following;

HOSPITAL MANAGEMENT COMMITTEE

This comprises of all heads of clinical units and members of the core management. It is the highest decision

making body of the hospital. It meets once every 6 months.

CORE MANAGEMENT TEAM

1) Quality assurance

2) Procurement

45

3) Staff durbar

4) Unit heads meeting

46

47

48

4.8 PREMIUM COLLECTION

Owing to the administered questionnaire, the researchers assessed a sample of the

insured concerning the amount they pay as premium for subscribing to the Health

Insurance Scheme. It was revealed that, the premium is affordable. Less than 10% of

the sample chosen for the assessment considered the premium and the amount on

renewal as expensive. In conclusion, the research revealed that, about 90% of the

insured said that the premium is affordable and moderate.

The preferred time for the renewal of National Health Insurance cards was also

explored by the study. The results indicated that, insured persons have to get their

cards renewed 3 months earlier, before the expiry date of the insurance cards and if

one fails to do so, and renew later after the expiry date, he/she will lose the access to

health care for some number of months after the renewal.

4.9 BENEFITS PACKAGES OF THE SCHEME

The benefits packages of the National Health Insurance Scheme in the Sunyani

Municipality are that, it provides access for renewals and registration of people in the

Sunyani Municipality, payment of inpatient and out patient bills and payment of all

accident bills. Though the benefits package of the scheme is not diseased based, but it

has total coverage of footing up the bills of socialization as its key benefit package. It

could be inferred from the research that it covers all the ten top diseases as shown in

the table below.

49

Table 4.5 showing ten top diseases as at 2011

Number Name of disease 2011

Cases reported Percentages (%)

1 Malaria 14241 32.6

2 Acute eye infection 6963 16

3 Acute ear infection 4864 11.15

4 Diarrhoea 4146 9.5

5 Respiratory tract infection 3018 6.92

6 Rheumatism and joint pain 2543 5.83

7 Hypertension 2414 5.53

8 Gynaecological conditions 2212 5.07

9 Skin diseases 1637 3.75

10 Home occupational accident 1567 3.6

Totals 43605 100

Research field, May, 2012

4.10 CONTRIBUTION OF HEALTH INSURANCE SCHEME TO HEALTH

CARE.

To enable the researchers know the contributions that the Health Insurance Scheme

have had on the citizens of Sunyani Municipality, questionnaire was distributed to a

50

sample of the population (both the insured and non insured) and the various responses

got from them were factored in the table below.

Table 4.6 Views of the Insured and Non-insured to know whether Health

Insurance has made health access better.

Insured Non-insured

Reduction in self medication 25% 75%

Easy access to health care 95% 5%

Quality health care 87% 23%

Health bills paid 80% 20%

Source: field research, 2012

Figure 4.1 A bar graph indicating views of insured and Non-insured to know

whether Health Insurance has made health access better

Reduction in self medica-

tion

Easy access to health

care

Quality health care

Health bills paid

0102030405060708090

100

25

9587

8075

5

23 20InsuredNon-insured

Insured and Non-insured

Perc

enta

ges (

%)

51

The above diagram indicates that about 70% of the Insured in the Sunyani

Municipality revealed that the Health Insurance Scheme has made health care better

in the Municipality. From the table above, it can be seen that about one third of the

insured as compared to that of the non-insured said that the National Health Insurance

Scheme has reduced self medication.

From the percentages given, almost twice the insured as compared to the non- insured

thought that Health Insurance has offered easy access to health care. On the other

hand, about 75% of the non- insured as against 25% of the insured said that health

bills are paid by the scheme that has made health care better.

4.11. PERCEPTION TO KNOW WHETHER HEALTH INSURANCE HAS

MADE HEALTH CARE WORSE.

The study results demonstrates the knowledge of both the insured and the non-insured

of what the scheme offers to members and members alike or highlights some of the

inherent reasons given by the non-insured for not wanting to join the scheme and

some of the grievances of the insured. This can be shown in the table below.

52

Table 4.7 indicating the perception of the people in the Sunyani Municipality on

the Health Insurance Scheme

Non-insured Insured

Increase in self medication 10 2

No membership 2 9

Patients discharged not fully recovered 40 0

NHIS Does not cover all health bills 45 27

Difficult access to health care 13 6

Source: Field Research, 2012

Figure 4.2 a bar graph showing perception to know whether NHIS has made

care worse

0

10

20

30

40

102

4045

13

Non-insuredInsured

Perc

enta

ges (

%)

4.12 REASONS FOR NOT JOINING THE NATIONAL HEALTH SCHEME.

53

The opinions of the non- insured in the Sunyani Municipality are very crucial to the

development of the Municipality Health Insurance Scheme. These indicate the low

coverage under the scheme and also unearth issues to help in increasing health

insurance scheme membership in terms of population and geographical coverage.

Some of the reasons the non-insured gave for not joining the scheme were that they

did not have money during the period of registration about 44%, other reasons were

that the scheme does not cover all medical bills (11%), subscription premium is too

expensive (10%), seeks treatment elsewhere (6%), delay in service provision (15%),

poor quality service by service providers (14%). The above were the reasons given by

the non- insured for not joining the scheme and are shown in the table below.

Table 4.8 indicating the reasons for not joining the scheme by the non-insured

Reasons Percentage

Lack of money for subscription 44%

NHIS Does not cover all services provided 11%

High subscription premium 10%

Seeks treatment elsewhere 6%

Delays in service 15%

Poor quality service 14%

Total 100%

Source: Field Research, 2012

54

Figure 4.3 Pie chart showing main reasons for not joining the scheme by the

non-insured

A 44%

B 11%

C 10%

D 6%

E 15%

F 14%

Lack of money for subscriptionNHIS does not cover all services provided High subscription premiumSeeks treatment elsewhereDelays in service provisionpoor quality service

Interpretations

A. Lack of money for subscription

B. NHIS does not cover all services provided

C. High subscription premium

D. Seeks treatment elsewhere

E. Delays in service provision

F. Poor quality service

55

4.13 SUGGESTIONS ON THE SUSTAINABILITY OF THE SCHEME BY

THE INSURED

The insured suggested that, the scheme should limit the number of months used in

processing the cards which constitute about 10% of the sample chosen. 25% of the

insured also suggested that, those who want to join the scheme should subscribe in

time to raise money for the scheme’s financial sustainability, 20% also suggested for

intensive education to encourage the payment of the premium. Other responses

totaled 30% and 15% did not respond either.

Table 4.9 Suggestions made by the respondents

Reasons Percentages

Limit the months of processing cards 10%

Prompt payment of premium 25%

Massive education and encouragement 20%

Other responses 30%

No response 15%

Totals 100%

Source: Field Research, 2012

56

Figure 4.4 a bar graph showing Suggestions made by the respondents

Reduce

the months o

f pro

cessin

g card

s

Prompt p

aymen

t of p

remium

Massive

educati

on and en

courag

emen

t

Other res

ponses

No response

05

101520253035

10%

25% 20%30%

15%

57

CHAPTER FIVE

SUMMARY CONCLUSIONS AND RECOMMENDATIONS

5.0 INTRODUCTION

This chapter summarizes the findings of the research conducted and draws

conclusions on the findings and finally gives recommendations on how to solve the

problems that cropped up in the previous chapter and possibly give suggestions to

improve the scheme’s operations.

These findings and recommendations will serve as a guide for the Sunyani

Municipality as well as how the Health Insurance Scheme is been financed in

consonance with the National Health Insurance Act of the country.

5.1. SUMMARY

The motive of this research work was to make an enquiry into Health Insurance as an

alternative source of financing health care and a means of sustaining the health sector.

During the course of the study, it was realized that the rate at which people subscribe

to the National Health Insurance Scheme in the Sunyani Municipality, has shot-up

since its inception in the Municipality. It is believed that Health Insurance is an

attractive and affordable source of finance by which accessibility to quality health

58

care is achieved. These are based on the objectives of National Health Insurance

Scheme such as to ensure;

a) Quality health care with an authority of the National Health Insurance Scheme

to foot the medical bills of the registered members with quality care given to

patients not based on the individual ability to pay subscription premium. This

measure is undertaken to know the premium for subscribing to the NHIS and

whether the premium does not lose value within a shorter possible time and

also

b) Ensure a smooth transition from the cash and carry system to the NHIS

c) Sustain the health sector

5.2 FINDINGS

The study conducted by the research team revealed that premiums paid for

subscription to the NHIS maintains their value over time.

In summary, for the management of fund to meet the operational cost of the NHIS

must;

1) Ensure the efficient use of funds since their core mandate is to bring quality

and affordable health care to all

2) Ensure that premiums are paid with exemptions due to capacities to pay and

subscription with respect to ages.

59

5.3 PERCEPTION OF PEOPLE IN THE SUNYANI MUNICIPALITY ABOUT

NHIS

The study revealed that, the popular perception of the people in the community is

that, the scheme does not cover all medical bills and sometimes extra money has to be

raised to foot bills. Others also have the perception that the scheme belong to the

people of the community, yet the people has little or no say on how it is being

operated. Other people also believe that the scheme has led to among other things the

following problems;

a) Inadequate quality care for the insured.

b) Cash and carry system seems to attract better health care than NHIS.

5.4 CONCLUSION

Ghanaians have been advocating for alternative health financing strategies. Health

Insurance Scheme was the most dominate of the suggestions raised during the period

of conducting this research in the Sunyani Municipality. The government of Ghana

wanted to replace the existing cash and carry system of financing the health sector

with the National Health Insurance Scheme, since the cash and carry system made it

compulsory to pay money before and after treatment which most patients could not

afford.

With the health insurance scheme, the cost incurred on health is spread over a group

of people over a given period of time. Any individual who belongs to the Health

60

Insurance Scheme contributes money periodically regardless of whether the

individual is sick or not.

5.5 RECOMMENDATIONS

From the study that was carried out on the National Health Insurance Scheme in the

Sunyani Municipality, improving effectiveness of the NHIS to the benefit of

subscribers can be achieved through the following;

a) Educational campaigns should be carried out massively on the scheme and its

operations within the Sunyani Municipality.

b) Subscribers should extend their knowledge of NHIS to others.

c) Resources should be made readily available to the NHIS to improve upon its

performance.

d) Ensuring proper utilization of idle resources for health care facilities.

61

APPENDIX A

REFRENCES

1. Appiah-Poku, J. (1997), Justice in health care, Ghana Medical Journal Vol. 3

Type Company Ltd. Accra-Ghana.

2. Atim C.(1997), Research on non-profit Mutual Health Organization in west

and central Africa, Analysis of Ghana case studier partnership for health

reform project

3. Bernet S. Crease A and Monash R. (1998), Health Insurance Scheme for

people outside formal sector employment, Avon Books Dept, New York

4. Daily Graphic, December 22, 2003, the graphic communication group ltd.

Accra-Ghana.

5. Donaldson C. and Gerald K. (1993), Economics of health care financing.

PTTS bourgh press, Canada

6. John Agyekum Kuffour (2003), Speech delivered on NHIS.

7. K. O. (1986), Word employment report,Genever international Labour

organization.

8. LLO (1993), health care under social security in Africa. Academy press plc,

Lagos

9. Ministery of Health, Ghana (1996), Health sector 5-year program of work,

Accra-Ghana.

10. Mormand C. and Weber A. (1994), Social Health Insurance, Grudbook for

planning. Barbar publishing international. USA

62

11. Nolan B. and Tubat V (1993), Cost recovery in public health services, World

Bank, Economic development institute. Washiton DC

12. Turney Foshee, (August 26, 2011). Tuscaloosanews.com

13. Vogel R. J. (1996), Health insurance in sub-Sahara Africa, Genever Labour

Organisation,

14. Yogle R. (1990), Analysis of the three (3) National health proposals in sub-

Saharan Africa. Vol 5.271-285cited by Yao-Dublu Kwabla Kenneth

63

APPENDIX B

SUNYANIN POLYTECNIC

HND ACCOUNTANCY DEPARTMENT

INTERVIEW OF THE STAFF OF HEALTH INSURANCE SCHEME

This interview is designed to assist in assessing the benefits associated with the

National Health Insurance Scheme in the Sunyani Municipality.

The purpose of the study is purely academic and any confidential information

provided about the scheme will be treated as such. I will be deeply pleased if you

answer the following questions.

1. What are your responsibilities towards ensuring better health care of the

citizenry?

…………………………………………………………………………………

………………………………………………………………………

2. How much should a person pay to get registered under the

NHIS?..................................................................................................................

3. Are there any incentives to encourage people to renew their insurance cards

even if they are not

ill?.......................................................................................................

64

4. What is the position of the scheme in meeting the financial requirements of

those who subscribe to the

NHIS?......................................................................................

5. What measures are being put in place to ensure the contingency of the

subscribers?..........................................................................................................

6. To what extent are the increasing figures of those who subscribe to the

scheme to that it is

beneficial?.....................................................................................................

7. Does the NHIS cover all medical bills, drugs and all the services given to a

patient?.................................................................................................................

8. How does the NIHS generate funds to meet the expenditure incurred on the

subscribers to the

scheme?..........................................................................................

…………………………………………………………………………………

………………………………………………………………………………

9. How does the scheme foot the bills of its registered members?

…………………………………………………………………………………

…………………………………………………………………………………

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APPENDIX C

SUNYANI POLYTECHNIC

DEPARTMENT OF ACCOUNTANCY

QUESTIONNAIRE FOR THE GENERAL PUBLIC

This questionnaire is designed to assist in assessing the benefits associated with the

National Health Insurance Scheme in the Sunyani Municipality.

The purpose of the study is purely academic and any confidential information

provided about the scheme will be treated as such. I will be deeply pleased if you

answer the following questions.

Kindly tick in any of the spaces provided under each question below

1. Age 10-20years[ ] 21-40years[ ] 41-60years[ ]

2. Gender Male[ ] Female[ ]

3. Marital status Married[ ] Single[ ] Separated[ ]

4. Number of children 1-3[ ] 4 and more[ ] None[ ]

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5. Number of dependants 1-3[ ] 4 and more[ ] None[ ]

6. What is your monthly estimated income? GH₵50-100[ ] GH₵100-150[ ]

GH₵150-200and above[ ]

7. Educational background Basic level[ ] Secondary level[ ] Tertiary

level[ ] None[ ]

8. Occupation Civil servant/public sector[ ] Self employed/private

sector[ ]

9. Have you heard about the National Health Insurance Scheme? Yes[ ] No

[ ]

10. Where did you hear the information? Church[ ] Radio[ ] Internet[ ]

11. Are you registered under the Health Insurance Scheme? Yes [ ] No [ ].

Give reasons for your answer.

…………………………………………………………………………………

…………………………………………………………………………………

12. How long have you being with the scheme? Please be specific

…………………………………………………………………………………

………………………………………………………………………………

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13. How much did you pay as a premium as an individual?

…………………………………………………………………………………

………………………………………………………………………………

14. How much did you pay as premium as a

household? ..........................................................................................................

..............................................................................................................................

..............................................................................................................................

....................

15. How much did you pay as SSNIT contributor?

…………………………………………………………………………………

…………………………………………………………………………………

16. How did you register? Formal Sector[ ] Informal Sector[ ]

17. Who finance the premium? Self[ ] Spouse[ ] Parents[ ] SSNIT[ ]

Other relatives

18. Have you benefited from Health Insurance? Yes [ ] No [ ]. How?

…………………………………………………………………………………

…………………………………………………………………………………

19. How many times have you been to the hospital since you registered? 1-5[ ]

4-7[ ] 8-11[ ]

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20. Was it an inpatient or outpatient?

…………………………………………………………………………………

…………………………………………………………………………………

21. What was your annual expenditure on Health before subscribing to the Health

Insurance Scheme? Below GH₵50[ ] GH₵50-100[ ] GH₵100-500[ ]

GH₵500 and above[ ]

22. What can you say about their work, do you find it beneficial? Why?

…………………………………………………………………………………

…………………………………………………………………………………

………………………………………………………………………………

23. Does the Health Insurance meet your expectation? Yes [ ] No [ ]. Give

reasons for your answer.

…………………………………………………………………………………

……………………………………………………………………………

24. How many did you or any of your family members fall ill and sought Health

care?

…………………………………………………………………………………

…………………………………………………………………………………

………………………………………………………………………………

25. In your opinion, what should the scheme do to encourage people to join the

scheme?

…………………………………………………………………………………

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…………………………………………………………………………………

…………………………………………………………………………………

26. In your opinion do you think the scheme is sustainable in the future? Yes [ ]

No [ ]. Explain your answer.

…………………………………………………………………………………

…………………………………………………………………………………

………………………………………………………………………………

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