The Provider Payment System of the National Health Insurance Scheme in Ghana

Abstract

The overriding concern of this paper is to examine opportunities and constraints of provider-payment system being used to manage health insurance in Ghana. Mindful of this objective, the study employed a survey approach to collect data, which involved the use of questionnaires, interviews and observation. Three out of the ten administrative regions were randomly selected to for the study. Thirty insurance schemes and 30 health service providers were randomly selected given that regions were our unit of analysis. Apart from these, 50 subscribers were purposively selected from Greater Accra; Central, Brong-Ahafo, and Ashanti regions were sampled for the study with a response rate of 97%. The results of the study show that inadequate funding characterised by delays in the release of subsidies result in the interruption of payment to service providers. Though the payment system is rated as satisfactory, it does not allow providers to achieve reasonable cash flow and as such it affects the value of health care provided to subscribers. The disruptions in re-imbursements can potentially undermine quality of health services provided to subscribers. It is therefore recommended that the national insurance authority devised mechanisms that will ensure prompt payment to providers as one of the several means of promoting quality healthcare.

Key words: District mutual health insurance scheme; National health insurance scheme; Provider payment system