Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Health Policy Management and Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Health Syst Reform. 2022 Mar 1;8(2):e2058337. doi: 10.1080/23288604.2022.2058337.
Ghana is a lower-middle-income economy that has made significant efforts to improve its health system, in order to achieve universal health coverage. Ghana has adopted strategic health purchasing as an important tool for efficient utilization of resources. This paper focuses on Ghana's National Health Insurance Scheme (NHIS) analyzing its governance arrangements and purchasing functions; and providing recommendations for improvement. The study applied the Strategic Health Purchasing Progress Tracking Framework co-created by the Strategic Purchasing Africa Resource Center (SPARC) and its partners to collect data from secondary and primary sources between September 2019 and June 2020. A descriptive and narrative approach was used to synthesize information on the NHIS governance arrangements and purchasing functions based on the framework. Benchmarks were used to describe the NHIS on the continuum from passive to strategic purchasing and to identify steps to make purchasing more strategic. Strengths and weaknesses were found in governance and purchasing functions. Progress was seen in how the NHIS selects the services in the benefit package, regularly reviewing the package to respond to the health needs of the population, and in how it selectively contracts with providers, particularly private providers, to ensure that standards for quality of care are met. However, challenges remain in performance monitoring, due to claims being mostly processed manually, and provider payment, due to frequent unbundling and upcoding of services Ghana has made significant strides toward the achievement of universal health coverage, but there is room for improvement in provider payment and performance monitoring.
加纳是一个中低收入经济体，为实现全民健康覆盖，在改善卫生系统方面做出了巨大努力。加纳采用战略卫生采购作为有效利用资源的重要工具。本文重点关注加纳的国家健康保险计划（NHIS），分析其治理安排和采购职能；并提供改进建议。该研究应用了由战略采购非洲资源中心（SPARC）及其合作伙伴共同创建的战略卫生采购进展跟踪框架，从 2019 年 9 月至 2020 年 6 月期间从二级和一级来源收集数据。根据该框架，采用描述性和叙述性方法综合 NHIS 治理安排和采购职能的信息。使用基准来描述 NHIS 在从被动到战略采购的连续体上的位置，并确定使采购更具战略性的步骤。在治理和采购职能方面发现了优势和劣势。在 NHIS 选择福利套餐中的服务方面、定期审查套餐以满足人口健康需求方面，以及在选择性与提供者（特别是私人提供者）签订合同以确保护理质量标准得到满足方面，都取得了进展。然而，在绩效监测方面仍然存在挑战，这主要是由于索赔大多是手动处理的，在提供者付款方面也存在挑战，这是由于服务经常被拆分和编码。加纳在实现全民健康覆盖方面取得了重大进展，但在提供者付款和绩效监测方面仍有改进的空间。
