Trade-Off Between Price And Improvement In Quality Of Service On Utilisation Of Public Health Facilities In The Ashanti Region Of Ghana

ABSTRACT This thesis assessed quantitatively, the improvement of drug availability at two district hospitals, two urban and two rural health centres in the Ashanti Region of Ghana after the introduction of “Cash and Carry” policy in the country. The supply situation of these public institutions in both periods was compared to the coverage of the facilities by using panel data analysis. As an input to the debate on the design of the national health insurance scheme, the work also used contingent valuation methods to assess the willingness of patients to change their current out of pocket payment system for drugs. On average the percentages of desired drug quantities and drug types that were supplied increased remarkably. The findings on coverage trends were mixed. One of each of the two facilities in the rural, urban and district communities had its coverage reduced in the post period while the other ones in the same community types had theirs improved. The study re-emphasises the importance of drugs in the delivery of health care in the public health institutions in Ghana. The relative negative responsiveness of coverage to price changes in the pre-period was greater than the post-period, implying that patients are more likely to pay higher fees in improved quality periods. There was also high acceptance of prepayment scheme for drugs in these communities. The improvement in quality of care like drug availability has a big role to play in the delivery of health care in Ghana. There is the need to minimise the effects of the noticeable bottlenecks in the improvement of quality of care like management inefficiencies, under staffing in remote areas and the unfunctional credit facilities set up for the needy in society. It is also recommended that there should be a simple and selective, but affordable health insurance package for drugs to at least serve as a start for the implementation of the national health insurance policy that has remained a dream for more than a decade.