An exploration of moral hazard behaviors under the national health insurance scheme in Northern Ghana: a qualitative study
Identifieur interne : 000394 ( Main/Exploration ); précédent : 000393; suivant : 000395An exploration of moral hazard behaviors under the national health insurance scheme in Northern Ghana: a qualitative study
Auteurs : Cornelius Debpuur [Ghana] ; Maxwell Ayindenaba Dalaba [Ghana] ; Samuel Chatio [Ghana] ; Martin Adjuik [Ghana] ; Patricia Akweongo [Ghana]Source :
- BMC Health Services Research [ 1472-6963 ] ; 2015.
Abstract
The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 through an Act of Parliament (Act 650) as a strategy to improve financial access to quality basic health care services. Although attendance at health facilities has increased since the introduction of the NHIS, there have been media reports of widespread abuse of the NHIS by scheme operators, service providers and insured persons. The aim of the study was to document behaviors and practices of service providers and clients of the NHIS in the Kassena-Nankana District (KND) of Ghana that constitute moral hazards (abuse of the scheme) and identify strategies to minimize such behaviors.
Qualitative methods through 14 Focused Group Discussions (FGDs) and 5 individual in-depth interviews were conducted between December 2009 and January 2010. Thematic analysis was performed with the aid of QSR NVivo 8 software.
Analysis of FGDs and in-depth interviews showed that community members, health providers and NHIS officers are aware of various behaviors and practices that constitute abuse of the scheme. Behaviors such as frequent and ‘frivolous’ visits to health facilities, impersonation, feigning sickness to collect drugs for non-insured persons, over charging for services provided to clients, charging clients for services not provided and over prescription were identified. Suggestions on how to minimize abuse of the NHIS offered by respondents included: reduction of premiums and registration fees, premium payments by installment, improvement in the picture quality of the membership cards, critical examination and verification of membership cards at health facilities, some ceiling on the number of times one can seek health care within a specified time period, and general education to change behaviors that abuse the scheme.
Attention should be focused on addressing the identified moral hazard behaviors and pursue cost containment strategies to ensure the smooth operation of the scheme and enhance its sustainability.
The online version of this article (doi:10.1186/s12913-015-1133-4) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12913-015-1133-4
PubMed: 26472051
PubMed Central: 4606991
Affiliations:
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wicri:level="1"><nlm:aff id="Aff1">Navrongo Health Research Centre, Navrongo, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Navrongo Health Research Centre, Navrongo</wicri:regionArea><wicri:noRegion>Navrongo</wicri:noRegion></affiliation></author><author><name sortKey="Dalaba, Maxwell Ayindenaba" sort="Dalaba, Maxwell Ayindenaba" uniqKey="Dalaba M" first="Maxwell Ayindenaba" last="Dalaba">Maxwell Ayindenaba Dalaba</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Navrongo Health Research Centre, Navrongo, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Navrongo Health Research Centre, Navrongo</wicri:regionArea><wicri:noRegion>Navrongo</wicri:noRegion></affiliation></author><author><name sortKey="Chatio, Samuel" sort="Chatio, Samuel" uniqKey="Chatio S" first="Samuel" last="Chatio">Samuel Chatio</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Navrongo Health Research Centre, Navrongo, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Navrongo Health Research Centre, Navrongo</wicri:regionArea><wicri:noRegion>Navrongo</wicri:noRegion></affiliation></author><author><name sortKey="Adjuik, Martin" sort="Adjuik, Martin" uniqKey="Adjuik M" first="Martin" last="Adjuik">Martin Adjuik</name><affiliation wicri:level="3"><nlm:aff id="Aff2">INDEPTH Network, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>INDEPTH Network, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Akweongo, Patricia" sort="Akweongo, Patricia" uniqKey="Akweongo P" first="Patricia" last="Akweongo">Patricia Akweongo</name><affiliation wicri:level="4"><nlm:aff id="Aff3">University of Ghana, School of Public Health, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University of Ghana, School of Public Health, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author></analytic><series><title level="j">BMC Health Services Research</title><idno type="eISSN">1472-6963</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 through an Act of Parliament (Act 650) as a strategy to improve financial access to quality basic health care services. Although attendance at health facilities has increased since the introduction of the NHIS, there have been media reports of widespread abuse of the NHIS by scheme operators, service providers and insured persons. The aim of the study was to document behaviors and practices of service providers and clients of the NHIS in the Kassena-Nankana District (KND) of Ghana that constitute moral hazards (abuse of the scheme) and identify strategies to minimize such behaviors.</p></sec><sec><title>Methods</title><p>Qualitative methods through 14 Focused Group Discussions (FGDs) and 5 individual in-depth interviews were conducted between December 2009 and January 2010. Thematic analysis was performed with the aid of QSR NVivo 8 software.</p></sec><sec><title>Results</title><p>Analysis of FGDs and in-depth interviews showed that community members, health providers and NHIS officers are aware of various behaviors and practices that constitute abuse of the scheme. Behaviors such as frequent and ‘frivolous’ visits to health facilities, impersonation, feigning sickness to collect drugs for non-insured persons, over charging for services provided to clients, charging clients for services not provided and over prescription were identified. Suggestions on how to minimize abuse of the NHIS offered by respondents included: reduction of premiums and registration fees, premium payments by installment, improvement in the picture quality of the membership cards, critical examination and verification of membership cards at health facilities, some ceiling on the number of times one can seek health care within a specified time period, and general education to change behaviors that abuse the scheme.</p></sec><sec><title>Conclusion</title><p>Attention should be focused on addressing the identified moral hazard behaviors and pursue cost containment strategies to ensure the smooth operation of the scheme and enhance its sustainability.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12913-015-1133-4) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 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