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Alhassan, Yussif Nagumse (2014) The role of the National Health insurance scheme in shaping equity of access to healthcare in Ghana. Doctoral thesis, London Metropolitan University.
In light of recent emphasis on achieving Universal Health Coverage through social health insurance in low income countries, this thesis examined how the National Health Insurance Scheme in Ghana impacts on equity of access to healthcare in Tamale District of northern Ghana. Using mainly a qualitative approach, the thesis specifically examined whether the NHIS promotes equity in health insurance coverage and whether insured members are able to access healthcare equitably. Against this background, four broad findings were identified. Firstly, even though the NHIS improved insurance coverage in the Tamale District, enrolment was largely inequitable because most socially disadvantaged groups/individuals were less able to insure. This was mainly because such groups were predisposed to developing low willingness and low ability to enrol in the NHIS as a result of their individual and community characteristics as well as NHIS and healthcare system factors. Secondly, the NHIS improved the affordability of healthcare services and reduced the risk of catastrophic healthcare expenditure among insured members, particularly insured low income households. Thirdly, while the NHIS improved the financial resources of healthcare providers and the availability of medicines and medical supplies, it adversely impacted on the general quality of healthcare services mainly because the supply of healthcare resources failed to keep up with a high demand for healthcare services by insured members. Fourthly, the NHIS also improved the use of formal care, particularly among insured low income households due to their greater healthcare needs and previous inability to afford the cost of healthcare services. However, due to long waiting times associated with accessing NHIS healthcare, the improvement in financial access to healthcare by the NHIS failed to eradicate the use of ‘informal’ forms of care (e.g. drugstore, herbal/traditional medicine) among insured members. Based on these findings, this thesis concludes that the NHIS could enhance equity in access to care if there are opportunities created to enable socially disadvantaged groups to enrol in the scheme as well as improve the availability and quality of healthcare services for insured members.
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