Abstract
Background: Health care consumers and providers’ behaviors can negatively affect the delivery and demand of health care, and adversely affect a well-functioning social health insurance scheme. Purpose: The study aimed to assess the effects of health care consumers’ and providers’ perspectives and behaviours on the implementation of Ghana’s National Health Insurance Scheme (NHIS). Material and Methods: The study used a cross-sectional exploratory qualitative approach guided by Grounded Theory for data collection and analysis. Twelve focus group discussions with insured and uninsured in urban and rural communities, 23 in-depth interviews with private and public providers’ staff, managers, directors of NHIS, and a desk review of relevant grey literature were conducted, and analyzed using thematic content analysis, triangulation, and synthesis. Results: Providers and health care consumers, wholly embraced the NHIS and capitation payment system as a good and efficient system. It could improve health care access, delivery, and outcomes, and quality of care, especially for the poor and vulnerable. However, negative behaviors of consumers such as impersonation, provider shopping, and negative provider behaviors, including poor attitudes, undercover charges, unapproved co-payments, moonlighting, unnecessary and delayed hospitalization of patients, and poor quality of care, were found to affect the effective and efficient implementation of the NHIS. Perception of being healthy, poverty, lack of solidarity, and poor quality of health care services were the main reasons for enrollment hesitancies.
