ABSTRACT
The research topic “the economic impact of National Health Insurance Scheme (NHIS) on health care delivery in Ghana” looks in brief the current practice of financing the health service, addressing the underlying inequalities, proving equal opportunities for the people to use current health services in Ghana and to find out the whether the NHIS is the convenient way of financing health service.
Among the main objectives of introducing the National Health Insurance Scheme (NHIS), it was observed that people preferred the National Health Insurance Scheme (NHIS) to the cash and carry system.
From the researcher’s observation, adults who are unemployed and do not receive any identifiable and constant support from anywhere for survival are taken care by the scheme.
From another observation, the internal revenue generation for the health facilities has increased tremendously, because most people now attend hospital. Previously, patients were not visiting the health facilities because of the high cost involve in the treatment.
The scheme seems to be good but it has its problems. These should also be examined and addressed. In the researcher’s observation, these problems were unveiled.
The inability of subscribers to identify the National Health Insurance check points for the registration and payment of premium.
Two forms of fraudulent claims are submitted to the scheme for reimbursement. These are subscriber’s fraud and service provider’s fraud.
Substantial subscriber’s fraud meant that clients tried to claim for reimbursement for drugs supplied outside the scheme’s pharmacy network. The service providers also tried to increase their profits by over-servicing patients, i.e., they performed procedures and tests that were uncalled for in order to boost claims.
Another major problem with the scheme is, as a result of the delays in claims payments and questionable vetting of the claims; the service providers began to under-service the scheme’s subscribers. This meant that the required protocols of care were not entirely adhered to by the service providers and the frustrated subscribers pulled out their support for the scheme. The NHIS, like all other programmes of similar nature has its challenges.
The entire work presents policies, recommendations, and conclusions concerning ways which the NHIS can improve the finance, efficiency, and quality of health system.
