Managerial Implications of Delayed Reimbursement of National Health Insurance Claims: The Case of two Hospitals in Northern Ghana

Abstract

This study examines the managerial implications of the unpredictable payment pattern and the extent to which the phenomenon affect quality healthcare delivery using Bolgatanga Regional Hospital and the Bawku Presbyterian Hospital as multiple case study. Qualitative case study design was employed using multiple cases of two hospitals to allow for an in-depth exploration of delayed reimbursement of claims. A total of 12 management members of the two hospitals and 10 scheme managers were selected for interviews. Significant statements from transcribed data generated themes through coding and categorization. The purchaser-provider split model underpinned the study analysis and discussions. The results showed that managerial activities of the two hospitals are characterized by prize discrimination, weak purchasing power and impromptu prioritization. Stock level for drug and non-drug consumables often depleted, leading to the emergence of a certain unscripted form of 'copayment'. Staff development, training and remuneration are halted, while basic diagnostic test could barely be carried out. The findings do not support the realization of technical and clinical quality. The paper recommends the creation of a separate account for NHIS funds and enforcement of sound financial management of the scheme's funds by the National Health Insurance Authority. A broader consultation is also recommended to explore the possibility of incorporating co-payment into the current system, to minimize cost of treatment burden as well as serve as a gate keeper.