Factors Affecting The Implementation Of The National Health Insurance Policy

ABSTRACT

Public policy implementation has been a critical issue in the local, national and international political discourse, and its importance cannot be overemphasized. The essence of arriving at the intended results of public policies and the subsequent debate on means to achieve this end has been an overarching issue in policy circles, among policy actors, and within policy communities during the past four decades. The study identified the factors affecting the implementation of National Health Insurance Policy. The study also identified the relationships that exist among these factors and the determinants of participation in the National Health Insurance Scheme (NHIS). To do this, the researcher used a combination of quantitative and qualitative approaches. Easton’s political systems theory was used as the theoretical lens for the study. Ghana’s NHIS was conceived as a system which takes demand and support inputs from the environment and converts them into outputs which are released back into the environment. The framework for the study also showed how political, economic, social and technological factors affected the implementation of the NHIS. The researcher adopted a pragmatic approach. This involved the use of a mixed methodology, using both qualitative and quantitative approaches. Also, the researcher adopted a descriptive case study design for the study. In all, the study was conducted in four districts of the NHIS, namely Ablekuma, Ayawaso, Ga, and Dangme West districts. These districts have a total population of 1,721,095 out of which the study targeted 1,101,770 persons who were 18 years old and above. To obtain the necessary empirical data, the researcher sampled 442 participants out of which 422 participated in the quantitative survey; and 20 participated in in-depth qualitative interviews. The sample size for the quantitative study was based on the recommended table for sample size determination by the Universal Accreditation Board which used a ±5% margin of error, yielding a 95% confidence interval. The concept of

xviii

saturation guided the determination of the sample size for the qualitative study. Respondents for the quantitative survey were selected using a convenience sampling technique. However, the respondents for qualitative interviews were purposively selected. The researcher found that age and marital status of respondents significantly affected respondents’ participation in the NHIS. Gender, educational status and employment did not significantly predict participation in the NHIS. The study also found that the government and politicians, the National Health Insurance Authority (NHIA) and health sector organisations/institutions (including healthcare providers, regulators and professionals greatly affected the implementation of the NHIS. In addition, the political, economic, social and technological segments of the environment significantly affected the NHIS implementation system. The economic segment was found to have the strongest influence on the NHIS implementation system and that the economic relief the NHIS brings to participants as well as the current economic conditions have greatly affected its implementation. It was also found that the pronouncements and activities of politicians have had a significant effect on the NHIS. The society on its part has contributed to the implementation of the NHIS by accepting it, supporting it and encouraging its members to join. Technological advancement also affected the implementation of the NHIS. Furthermore, the researcher found that there exist significant interrelationships between these factors. The political factor had the strongest relationships with all the other factors. The study made a significant contribution to knowledge by introducing a modified framework (which combines Easton’s Systems Theory and the Political, Economic, Social and Technological [PEST] environmental analysis) to investigate the implementation of public policy. Considering the fact that this hybrid framework is new and has not been adequately tested, the researcher recommends subsequent testing and use on the NHIS and other implementation issues.