Managerial problems of hospitals under Ghana's National Health Insurance Scheme

Hospital and health system managers are facing several problems following the introduction of Ghana's national health insurance policy. This study aims to investigate the opinions of health managers about the problems emanating from the national health insurance policy for hospital managers in regard to reimbursement, claims management, service delivery and waiting time. The study involved key informants from 12 National Health Insurance Scheme (NHIS) accredited district hospitals, which were purposively selected from five regions in Ghana. Data were collected using indepth personal interviews with managers of pharmacy, supply/procurement, accounts and insurance scheme units of the hospitals. Data analysis was guided by the major themes that emerged during the interviews. A framework approach to analysis was used, grouping and incorporating themes and subthemes that emerged from the interview data. The major findings identified by interviewees with regards to problems confronting hospital management were: cash flow delays from the health insurance authority; lack of capacity to procure essential drug and nondrug consumables; and the inability to take initiatives and carry on effective administrative work. Other problems identified by the interviewee included inadequate logistics and human resources, limited space within the hospitals to cope with the increasing number of service users and “moral hazard” on the part of policy holders. The NHIS has brought many organizational and service management challenges to hospitals. To overcome these challenges, services under the health insurance authority need to be streamlined to remove cash flow bottlenecks. Also, accredited hospitals need to adopt and use new technology, especially computerization and automation of the health insurance service delivery system. This would enable the authority to cope with the huge management problems confronting hospitals and the national insurance scheme. Above all, appropriate fund management systems would have to be established in the hospitals to reduce moral hazards.