Demand And Supply-Side Factors of Healthcare Under National Health Insurance in Ghana: Implications for Universal Health Coverage in the Wa Municipality

Abstract

This study examines the interaction between demand and supply-side models of national health insurance in Ghana. The purpose of the study was to examine how the supply of healthcare influences insured persons’ access and use of primary healthcare services under Ghana’s NHIS in the Wa Municipality. An explanatory sequential mixed methods design was used. The cluster sampling technique was used to select 413 insured persons at the community level and in 47 health care facilities using a questionnaire, for quantitative analysis. Purposive sampling technique was used to select 17 healthcare providers and 20 insured key informants for further qualitative investigations using an interview guide. The quantitative data were analysed using descriptive statistics, inferential statistics and structural equation model (SEM). The qualitative data were analysed based on themes to further explain the quantitative results. The results show that determinants of supply of healthcare (SoHDs) positively influenced NHIS utilisation. Insured persons’ who have active membership were able to demand access and used (DAU) primary health care (PHC) services in accredited health facilities, with the exception of private laboratory diagnostic centres and pharmacies. The study found that dimensions of access to PHC; availability, acceptability, affordability, and accommodation as provided by healthcare providers were important factors influencing insureds' decision to renew membership. The frequency with which the insured used NHIS to access PHC services had a positive impact on their decision to renew membership. SoHDs and DAU were positive reverse causality factors influencing each other and insured persons' decision to utilise NHIS for PHC services. Taking into account socio-demographic, economic, and health characteristics (SEHCs); gender, education level, average monthly income, location, health seeking behaviour, average distance in minutes to the health facility, and cost to and from the health facility were significant factors affecting insureds' perceptions regarding SoHDs, their access to and use of NHIS for PHC. The study concludes that SEHCs, SoHD and DAU are critical factors affecting NHIS in Ghana. The study recommends that NHIA implements policies that keep an eye on SoHD and DAU with SEHC to achieve UHC and SDG 3, which is health for all by 2030.