Health sector reforms : a study of mutual health organisations in Ghana

This thesis examines the problems of health financing and the emergence of Mutual Health Organisations under the health sector reforms in Ghana. Governments of sub-Saharan Africa region have embraced the Community-based health insurance schemes concept under the health sector reforms, with momentous enthusiasm. They believe that these newly emerging health financing arrangements could easily be utilised as platforms for initiating Social Health Insurance strategies to reach the economically deprived people. Without such schemes, citizens would become poorer because they would have had to dispose of their family's wealth in order to treat a member who falls sick. Ghana, a developing country in West Africa has introduced a National Health Insurance Scheme, which is fused with Social health insurance and Community-based health insurance schemes. This study examines pro-active plans to address the financial viability of the schemes, to prevent them from going insolvent. The study generally, investigates health sector reforms in the context of Ghana. Four operating District Mutual Health Insurance Schemes (MHOs) were selected using geographical locations, among other criteria, as case studies. Data was gathered through interviews. The findings of the empirical study were analysed and interpreted using social policy and community field theories with the support of available documents. The evidence from the study concludes that government's intervention (implementation of NIH Act 650) has increased and expanded the membership base of the schemes: from small group-based to district-wide schemes under the ambit of the District Assemblies. However, such intervention has equally led to diminished community initiatives in establishing, and the complete collapse of the original small group-based schemes. The study also finds among other things that: The financial viability of the schemes depends on the provision of long-term government subsidy. However, they may not be financially viable beyond subsidy-funding due to uncontrollable high utilisation rate, occurrence of health insurance fraud, moral hazard and associated exorbitant claims made on them by health care providers. There are problems with late release of reimbursement funds for discharging with claims by the central government. This has impacted heavily on the financial and strategic management and decision making processes of health institutions in the operating districts. Health managers are unable to fulfil their contractual obligations to their suppliers as their capital funds are locked up with the Mutual Health Organisations that arc also unable to provide front loading for the health providers even up to a period of three (3) months of their financial operational requirements. There is therefore. a perceived tension between the schemes and the health institutions as the health institutions prefer to treat clients who come under the 'cash and carry' group since they provide prompt payment to the detriment of insured clients whose reimbursement is delayed causing the institutions to be cash-trapped. This is recommended for immediate attention.