Exploring Factors Influencing Health Facilities’ Decisions Not to Enrol in Ghana’s National Health Insurance Scheme (NHIS)

Introduction: Given that enrolment in Ghana’s National Health Insurance Scheme (NHIS) is not mandatory, all citizens must, by law, be members of a health insurance scheme in Ghana. Further, the law does not require all health facilities in Ghana to enrol in the NHIS. However, private health insurance schemes must contract only with credentialed (NHIS-accredited) providers. Despite the NHISs’ objective of eliminating financial barriers and promoting equitable access to healthcare, some health facilities are not NHIS members. In this study, we aimed to understand the reluctance or inability of health facilities to participate in NHIS. Materials and Methods: In-depth interviews were conducted to gather information on the reasons for non-enrolment in the NHIS among health insurance officers across Ghana’s three ecological zones. The study participants engaged directly with healthcare providers and insurance authorities and had an understanding of the administrative processes and policy implications of the research area. Data were collected from 7 June to 28 June 2023. The transcripts of the in-depth interviews were analysed using both inductive and deductive thematic approaches. Results: Fifteen in-depth interviews among health insurance officers were conducted. We found that a few facilities are exiting the NHIS, while many are joining it. Private health facilities, including pharmacies and eye clinics, are most affected. Reasons for leaving or not enrolling in the scheme include delays in reimbursement, the country’s economic situation, the death of the head of the health facilities, and a mismatch between the tariff and market prices. Conclusions: To enhance the sustainability of NHIS and achieve universal health coverage (UHC), timely reimbursements, financial support for medication purchases, and the direct allocation of NHIS funds into the National Health Insurance Fund must be adhered to.