The Challenge of Concurrently Sustaining Private and Public Development Initiatives: A Case Study of Public and Private Mutual Health Insurance Schemes in Ghana.

The direct and indirect economic cost associated with health care have a strong relationship with access to health care. Since the 1980s, user fees had constituted a well-documented barrier to health care in Ghana when patients were made to pay for the full cost of medication and care. The disadvantages of the user fee policy encouraged the introduction of health insurance scheme in 2003. However, the simultaneous implementation of this initiative alongside other private efforts has sometimes been problematic in terms of sustainability due to policy and strategic differences. The paper uses the packages offered by selected public (Atwima Nwabiagya District Mutual Health Insurance Scheme) and private St. (Peters Co-operative Credit Union Mutual Health Scheme) health insurance schemes to appreciate the sustainability of these schemes based on issues relating to client satisfaction. The data for the paper started in 2009 and continued in 2014 using a combination of quantitative and qualitative research approaches to gather the primary and secondary data from approximately 200 primary participants and 4 key informants. Owing to factors such as coverage area and conditions for membership as well as benefit packages, enrolment levels, attitudes of staff, types and availability of health facilities and drug and mode of premium contribution, the public initiative demonstrated comparatively greater prospects and sustainability after the first phase of data collection. However, due to a myriad of challenges, the private scheme had indeed collapsed during the second phase of data collection. The paper thus suggests that, both public and private health finance related initiatives should be given the necessary support by relevant state institutions such the National Health Insurance Authority (NHIA). This is due to the fact that, in favorable conditions, both sectors could contribute to alleviating the financial constrains of access to health services especially among the poor and vulnerable. Keywords and Phrases: healthcare, health insurance, health care financing, public and private, sustainability, Ghan