Alhassan Robert Kaba, Nketiah-Amponsah Edward, Arhinful Daniel Kojo
Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
PLoS One. 2016 Nov 10;11(11):e0165151. doi: 10.1371/journal.pone.0165151. eCollection 2016.
The introduction of the national health insurance scheme (NHIS) in Ghana in 2003 significantly contributed to improved health services utilization and health outcomes. However, stagnating active membership, reports of poor quality health care rendered to NHIS-insured clients and cost escalations have raised concerns on the operational and financial sustainability of the scheme. This paper reviewed peer reviewed articles and grey literature on the sustainability challenges and prospects of the NHIS in Ghana.
Electronic search was done for literature published between 2003-2016 on the NHIS and its sustainability in Ghana. A total of 66 publications relevant to health insurance in Ghana and other developing countries were retrieved from Cochrane, PubMed, ScienceDirect and Googlescholar for initial screening. Out of this number, 31 eligible peer reviewed articles were selected for final review based on specific relevance to the Ghanaian context.
Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement. Moreover, poor quality care in NHIS-accredited health facilities potentially reduces clients' trust in the scheme and consequently decreases (re)enrolment rates. These sustainability challenges were reviewed and discussed in this paper.
The NHIS continues to play a critical role towards attaining universal health coverage in Ghana albeit confronted by challenges that could potentially collapse the scheme. Averting this possible predicament will largely depend on concerted efforts of key stakeholders such as health insurance managers, service providers, insurance subscribers, policy makers and political actors.
2003年加纳引入国家医疗保险计划（NHIS），这对改善医疗服务利用情况和健康结果做出了重大贡献。然而，活跃参保人数停滞不前、向NHIS参保客户提供的医疗服务质量不佳的报道以及成本上升，引发了人们对该计划运营和财务可持续性的担忧。本文回顾了关于加纳NHIS可持续性挑战与前景的同行评议文章和灰色文献。
对2003年至2016年间发表的关于加纳NHIS及其可持续性的文献进行电子检索。从考克兰图书馆、PubMed、科学Direct和谷歌学术搜索中总共检索到66篇与加纳及其他发展中国家医疗保险相关的出版物进行初步筛选。在这些文献中，基于与加纳情况的特定相关性，选择了31篇符合条件的同行评议文章进行最终评审。
NHIS在加纳继续运营的能力在财务和运营方面受到多种因素的威胁，这些因素包括：成本上升、可能的政治干预、技术能力不足、卫生设施和卫生工作者的空间分布、监测机制不完善、福利套餐宽泛、豁免群体庞大、客户教育不足以及社区参与有限。此外，NHIS认证的医疗机构中医疗服务质量差可能会降低客户对该计划的信任，从而降低（再）参保率。本文对这些可持续性挑战进行了回顾和讨论。
尽管面临可能导致该计划崩溃的挑战，但NHIS在加纳实现全民健康覆盖方面继续发挥着关键作用。避免这种可能的困境在很大程度上取决于医疗保险管理人员、服务提供者、保险订阅者、政策制定者和政治行为者等关键利益相关者的共同努力。
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