ABSTRACT

The National Health Insurance Scheme (NHIS) was introduced in Ghana in 2004. The scheme was brought on board a substitute for the then out-of-pocket system, popularly identified as the dreaded ‘cash and carry system’. This system required that clients pay healthcare service at the point of service. The reimbursement of claims by the National Health Insurance Authority (NHIA) has not been regular as it ought to be. This study assessed whether delays in claim payment by the NHIA affect healthcare service delivery by private hospitals in the Ga West and Ga North Municipality of the Greater Accra region.

Primary data was solicited and used for the study. A structured questionnaire was designed around four thematic areas namely claims management, reimbursement, service delivery and inpatient attendance. A mixed process approach involving both quantitative and qualitative research techniques are used in analyzing the data. A multiple regression model is estimated to analyze the impact of the delays in claim payment has on healthcare service delivery by private hospitals.

The study established that the delay in payment of claims by the NHIA does not necessarily affect the service delivery of private hospitals in the Ga West and Ga North Municipalities in the Greater Accra region. The study finds that private hospitals in the study site rely heavily on revenue from Private Commercial Health Insurance Scheme (PCHIS) and clients who pay cash at the point of service. The study concluded that NHIS accredited private hospitals are able to provide healthcare services even though the claim payment from the NHIS delays. The study,, however, identified some operational challenges such as difficulty in providing NHIS drugs, delay in paying creditors and payment of salaries in months where turnover from private insurance schemes are low.