Self-undermining policy feedback and the creation of National Health Insurance in Ghana

Ishmael Wireko, Daniel Béland, Michael Kpessa-Whyte

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Contributing to the ongoing debate about policy feedback in comparative public policy research, this article examines the evolution of healthcare financing policy in Ghana. More specifically, this article investigates the shift in healthcare financing from full cost recovery, known as 'cash-and-carry', to a nation-wide public health insurance policy called the National Health Insurance Scheme (NHIS). It argues that unintended, self-undermining feedback effects from the existing health policy constrained the menu of options available to reformers, while simultaneously opening a window of opportunity for transformative policy change. The study advances the current public policy scholarship by showing how the interaction between policy feedbacks and other factors-particularly ideas and electoral pressures-can bring about path-departing policy change. Given the dearth of scholarship on self-undermining policy feedback effects in the Global South, this contribution's originality lies in its application of the novel theory to the sub-Saharan African context.

Original languageEnglish
Pages (from-to)1150-1158
Number of pages9
JournalHealth Policy and Planning
Volume35
Issue number9
DOIs
Publication statusPublished - 1 Nov 2020

Keywords

  • Ghana
  • Health care
  • National Health Insurance Scheme
  • health insurance
  • policy change
  • policy feedback

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