Mandatory community-based health insurance schemes in Ghana : prospects and challenges

 

Show simple item record

dc.contributor.advisor McIntyre, Di en_ZA
dc.contributor.author Sabi, William Kwasi en_ZA
dc.date.accessioned 2014-11-09T15:51:40Z
dc.date.available 2014-11-09T15:51:40Z
dc.date.issued 2005 en_ZA
dc.identifier.citation Sabi, W. 2005. Mandatory community-based health insurance schemes in Ghana : prospects and challenges. University of Cape Town. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/9437
dc.description Includes bibliographical references (leaves 119-124). en_ZA
dc.description.abstract Community-Based Health Insurance Schemes are new forms of health financing that can increase resources available for a national health system. These schemes are often regarded as not feasible. Evidence from recent experiences however; show that , if they are appropriately designed and managed they can be feasible and sustainable. The successes achieved by such schemes in Ghana motivated the government to make them a mandatory system of health financing. The main objective is that every resident of Ghana shall belong to a health insurance scheme that adequately covers him or her against "cash and carry" (i.e. user fees) in order to obtain access to a defined package of acceptable quality needed health services without having to pay at the point of receiving service. This study sought to undertake a critical comparative study of the performance of voluntary and mandatory community health financing schemes in Ghana and assess their prospects and challenges in their effort to improve efficiency, equity and the schemes' sustainability. The study, a qualitative one, employed descriptive survey techniques to evaluate the ability of schemes to finance their activities from their own sources and mechanisms put in place to cater for the poor and vulnerable, i.e. to evaluate with sustainability and equity respectively. The study also considered control measures to minimize cost escalation to assess efficiency. Focus group discussions, key informant interviews and document reviews were used to examine performance of voluntary and mandatory schemes in meeting those criteria. The study found that both voluntary and mandatory schemes were not self-sustainable due to low coverage and inadequate funds mobilized by the schemes. The main reasons for the general low enrolments are poverty, poor quality health service and limited benefit packages. The study showed that including out-patient (OPD) services in the benefit package and quality improvements in health service improve members' acceptability of insurance hence increase membership rates which will eventually increase schemes' sustainability. Efficient and effective administration of risk equalization fund will help reduce differences in districts' ability to raise revenue owing to different levels of economic activities as well as local morbidities. The study showed further that small community-based health insurance schemes (CBHIS) could be sub-district level financial intermediaries for the District Health Insurance Schemes. It was found in this study that a practical means testing mechanism to declare one poor in order to quality for exemption from contribution should be adopted. The study also suggests that alternative reimbursement mechanisms to fee-for-service need to be considered. The study suggests further research on equity in access and means testing. Such study should consider coming up with mechanisms for identifying the very poor in the communities and to put in place workable and sustainable measure to tackle the financial barriers to health care they face. en_ZA
dc.language.iso eng en_ZA
dc.subject.other Health Economics en_ZA
dc.title Mandatory community-based health insurance schemes in Ghana : prospects and challenges en_ZA
dc.type Master Thesis
uct.type.publication Research en_ZA
uct.type.resource Thesis en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Health Economics Unit en_ZA
dc.type.qualificationlevel Masters
dc.type.qualificationname MPH en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Sabi, W. K. (2005). <i>Mandatory community-based health insurance schemes in Ghana : prospects and challenges</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit. Retrieved from http://hdl.handle.net/11427/9437 en_ZA
dc.identifier.chicagocitation Sabi, William Kwasi. <i>"Mandatory community-based health insurance schemes in Ghana : prospects and challenges."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit, 2005. http://hdl.handle.net/11427/9437 en_ZA
dc.identifier.vancouvercitation Sabi WK. Mandatory community-based health insurance schemes in Ghana : prospects and challenges. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Health Economics Unit, 2005 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/9437 en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Sabi, William Kwasi AB - Community-Based Health Insurance Schemes are new forms of health financing that can increase resources available for a national health system. These schemes are often regarded as not feasible. Evidence from recent experiences however; show that , if they are appropriately designed and managed they can be feasible and sustainable. The successes achieved by such schemes in Ghana motivated the government to make them a mandatory system of health financing. The main objective is that every resident of Ghana shall belong to a health insurance scheme that adequately covers him or her against "cash and carry" (i.e. user fees) in order to obtain access to a defined package of acceptable quality needed health services without having to pay at the point of receiving service. This study sought to undertake a critical comparative study of the performance of voluntary and mandatory community health financing schemes in Ghana and assess their prospects and challenges in their effort to improve efficiency, equity and the schemes' sustainability. The study, a qualitative one, employed descriptive survey techniques to evaluate the ability of schemes to finance their activities from their own sources and mechanisms put in place to cater for the poor and vulnerable, i.e. to evaluate with sustainability and equity respectively. The study also considered control measures to minimize cost escalation to assess efficiency. Focus group discussions, key informant interviews and document reviews were used to examine performance of voluntary and mandatory schemes in meeting those criteria. The study found that both voluntary and mandatory schemes were not self-sustainable due to low coverage and inadequate funds mobilized by the schemes. The main reasons for the general low enrolments are poverty, poor quality health service and limited benefit packages. The study showed that including out-patient (OPD) services in the benefit package and quality improvements in health service improve members' acceptability of insurance hence increase membership rates which will eventually increase schemes' sustainability. Efficient and effective administration of risk equalization fund will help reduce differences in districts' ability to raise revenue owing to different levels of economic activities as well as local morbidities. The study showed further that small community-based health insurance schemes (CBHIS) could be sub-district level financial intermediaries for the District Health Insurance Schemes. It was found in this study that a practical means testing mechanism to declare one poor in order to quality for exemption from contribution should be adopted. The study also suggests that alternative reimbursement mechanisms to fee-for-service need to be considered. The study suggests further research on equity in access and means testing. Such study should consider coming up with mechanisms for identifying the very poor in the communities and to put in place workable and sustainable measure to tackle the financial barriers to health care they face. DA - 2005 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2005 T1 - Mandatory community-based health insurance schemes in Ghana : prospects and challenges TI - Mandatory community-based health insurance schemes in Ghana : prospects and challenges UR - http://hdl.handle.net/11427/9437 ER - en_ZA


Files in this item

This item appears in the following Collection(s)

Show simple item record