Comparative Study of Community Perception of Quality of Care With The Inception of The National Health Insurance Scheme in The KASSENA NANKANA District

ABSTRACT 

Introduction: Ghana implemented the National Health Insurance Scheme (NHIS) with the objective of increasing health insurance coverage in the country against the need to pay outof-pocket at the point of service use. However with increasing utilization, anecdotal evidence suggests that community perception of health care is not overwhelmingly favourable. Method: A cross sectional, comparative and exploratory study conducted in the KassenaNankana District (KND) of Northern Ghana to evaluate the community perception of the quality of care following the introduction of the national health insurance scheme. Both quantitative and qualitative methods were employed in the data collection and analysis. Results: In general the results showed that both NHIS and non-NHIS clients perceive the health insurance scheme to be good (87.2% of those on NHIS and 89.7% for non- NHIS). There was a statistically significant difference in the perception of quality of health care between those who attended the hospital and those who attended health centres, as 95% of respondents who attended the hospital were less likely to perceive quality of care at the hospital as good compared to those who attended the Health Centres (OR =0.05, 95% CI: 0.025, 0.096), p < 0.001. The results also showed that NHIS clients were about 1.4 times more likely to perceive the quality of health care as satisfactory compared to non-NHIS clients. The difference was however not statistically different at 95% confidence level (OR =1.44, (95% CI: 0.79, 2.62), p = 0.230). Comparing perception before and during the implementation of the NHIS, results show that both NHIS and non-NHIS respondents at the health centres were satisfied with the quality of services with the implementation of the viii NHIS, however both NHIS and non-NHIS respondents at the hospital were somehow dissatisfied with the quality of health care following the implementation of the scheme. Conclusion: The general perceptions of the quality of health care at the health facilities in the Kassena-Nankana District by both NHIS and non-NHIS clients were said to be good. However, while the quality of health care at the health centre level was perceived by both NHIS and non-NHIS clients to have improved with the inception of NHIS, at the district hospital, the quality of care was perceived to be poor with the inception of the NHIS by both NHIS and non-NHIS clients.