The Ghana National Health Insurance Policy: Evaluation of Equity of Coverage and Financial Sustainability

Abstract

One of the overarching objectives of initiating and implementing public policy is to enhance and advance the welfare of citizens. It is in this disposition that the Ghana government in 2003 initiated a universal health insurance policy to alleviate the health needs of its growing population. It is also apparent that it is one thing initiating a policy and implementing it, and the other, ensuring that the policy meets or attains its intended objective. The Ghana National Health Insurance Policy has been operational for almost a decade; it is therefore incumbent that the policy is empirically examined to ascertain whether it meets its purported objective. To achieve its objective, the policy must as much as possible cover a wide section of the Ghanaian population, and must also be capable of sustaining itself financially. This study deployed a mixed method approach to examine whether the Ghana National Health Insurance Policy is equitable in terms of coverage and capable of financially sustaining itself. Data to provide answers to questions posed for the study were extracted through survey of both beneficiaries and non-beneficiaries of the program in selected regions of Ghana. Administrators of healthcare organizations were also quizzed on how their organizations interface with the implementing agency as it relates to reimbursement for services rendered to enrollees. Records of the implementing agency were also thoroughly scrutinized to determine its financial strength and how often it reimburses healthcare providers for services rendered to clients. The study utilized binary logistic analysis to ascertain whether the policy is equitable in terms of coverage. To satisfy equity requirement of the study, the various demographic makeup [determinants of equity] of the Ghanaian population was captured on a questionnaire to verify whether the program made room for citizens of different demographic groups. Depth of coverage [benefit package] of the program was also captured on the questionnaire, and included in the logistic analysis. Regression analyses are run to unravel why eligible citizens fail to sign up for the program, and whether the program is or was capable of sustaining itself financially. Content analysis to establish financial viability of the program is undertaking on materials extracted from the records of the implementing agency, and interviews of the selected healthcare providers’ representatives. Finally, similar policies in selected countries of the world are incorporated into the study to serve as benchmark for critically analyzing the Ghanaian program.