Assessing the Level of Client Satisfaction of the Nhis. a Study at Tema General Hospital

                                                                  CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF STUDY

Health is essential for the preservation of human species and an organised social life. The most valuable asset of every country is its citizens. Health is a state of complete, physical, mental, and social well being and not merely the absence of disease or infirmity.  Health is therefore a fundamental human right. Where large numbers of people are ill or physically unfit, low vitality, low productivity abound as a major social problem. The good health of nations is key to human development and economic growth and it is important to analyze health systems performance, (Brundtland G.H., 2001). The major challenge facing many countries lies in Ensuring that, everybody receives quality care, regardless of race, gender, geographic location, or ability to pay and reducing the gaps in health outcomes across different regions and socio economic and ethnic groups, (WHO, 2000). It is in fact a public right and therefore it is the responsibility of governments to provide health care to all people in equal measure (WHO 1946).

Financial constraint is one of the major barriers of access to healthcare for marginalized sections of society in many countries (Garg and Karan 2009; Peters et al. 2002; Pradhan and Prescott 2002; Ranson 2002; Russell 2004; Wagstaff and van Doorslaer 2003; Xu et al. 2003). It has been estimated that a high proportion of the world’s 1.3 billion poor have no access to health services simply because they cannot afford to pay at the time they need them (Dror and Preker et al. 2002). And many of those who do use services suffer financial hardship, or are even impoverished, because they have to pay (WHO 2010).

Health insurance is among the solutions promoted in developing countries since 1990’s to improve access to health care services because it avoids direct payment of fees by patients and spread the financial risk among all the insured. It is a way to distribute the financial risk associated with the variation of individuals’ health care expenditures by pooling costs over time through pre-payment and over people by risk pooling (OECD, 2004;). The prime objectives of health insurance are to: i) prevent large out-of-pocket expenditure; ii) provide universal healthcare coverage; iii) increase appropriate utilisation of health services; and iv) improve health status (International Labour Office 2008; WHO 2010).

Health care financing in Ghana began with a tax funded system that provided free public health care services to all after independence. Continued declines in government spending on health through the 1970s and 1980s led to shortages of medicines and supplies and deteriorating quality of care. Following adoption of structural adjustment reforms in 1983, the Rawlings administration raised and expanded user fees for public health care services in a system that became known as “cash and carry.” This user fee system was poorly regulated, inconsistently implemented, and found to have worsened access to care for the poor. Starting from the early 1990s, Ghana began to seek other ways of financing health care, including NGO initiated community-based health insurance schemes (CBHIS). This scheme was only targeted to specific areas and failed to address key social insurance issues, and was not supported by general government revenue to allow them to cater for the poor. (Blanchet et al., 2012)

Government of Ghana introduced National Health Insurance Scheme as a humane approach to bridge the financial barriers to proper and quality health care access. The idea of NHIS in Ghana was conceived by the former president John kuffour who when seeking the mandate of the people in 2000 elections, promised to abolish the cash and carry system of health delivery. In 2003, the scheme was passed into law, there was the establishment of Ghana National Health Insurance Authority which licenses, monitors and regulate the operation of health insurance schemes in Ghana. Similar to many countries in the world, Ghana’s health insurance was fashioned out to meet specific needs of Ghanaian citizens. The health insurance was set up to allow Ghanaian citizens to make contributions into a fund so that in the event of illness Ghanaian contributors could be supported by the fund to receive affordable health care (Nathan and Fink et al. 2002)

Every person in Ghana contribute according to the principle of ability to pay in order to enjoy a package of health services covering ninety five percent (95%) of diseases afflicting Ghanaians.  Persons in the formal sector contributed 2.5% of their 17.5% Social Security and National Insurance Trust (SSNIT) contribution whereas those in the informal sector also contributed at least Seven Ghana Cedes Twenty Pesewa (Gh¢ 7.20) per annum.  In addition to the funding of the scheme of persons working in the formal and informal sectors of the economy, government has put in place a framework for mobilizing additional funds to support the implementation of the scheme.  Government has instituted by law a 2.5% National Health Insurance Levy payable on selected goods and services.  Funds raised from this source would be used to subsidise the contributions of the under privileged segment of society and to pay for the contributions of the core poor and the vulnerable groups.  [Access from www.nhis.gov.gh on May 12, 2015 at 9:30am].

Client satisfaction with health service provision during the implementation of health insurance schemes has often been neglected since numerous activities take place concurrently. Consumers of health services must be involved and consulted, not only in relation to their own healthcare, but also about service planning and delivery, health evaluation and research (Graham, 2001). Everyone is a consumer of health services and it is important to know their expectations on health care services.  Users of health services want safe, appropriate interventions, treatment, and care that consider their dignity and respect. They want information that is accurate, timely, and relevant. Patient satisfaction measures therefore provide healthcare managers with useful information about the structures, process, and outcomes of care. They alert administrators of the positive and negative aspects of their institutions. Patients satisfaction assessments help maximize an organization’s quality and the value of the care it provides (Bell et al., 1997, Kelsey, 2001).

It’s important that client’s interest is put first. This will help health service providers to improve their services that they give at the various health institutions. Successful improvement would ultimately contribute to attaining quality care, the goal to quality assurance. It’s also important that patients are cared for properly, promptly, adequately and all the necessary information given to them and their relatives to understand and make choices which would eventually cure them and make them appreciative of the services provided. The higher the health satisfaction of a population, the better the quality of life for that population. To aid in social development and promote happiness among its people Governments need to examine their level of health satisfaction.  [Access from www.njcpoline.com on May 15, 2015 at 10:30am]. Therefore we are going to look at quality of care from the insurance clients perspectives. This will help health services providers to improve their services that they give at the various health institutions. Successful improvement would ultimately contribute to attaining quality care, the goal to quality assurance.

1.2 PROBLEM STATEMENT

Despite all the efforts by the Ghana Health Services, the central government, Donor Funding Agencies and all other stakeholders to improve quality health care delivery in Ghana, there is still perceived unsatisfactory services rendered by the staff of public hospitals in areas of care and treatment, relationship between patients and care givers, patients’ consent and confidentiality, sanitation of working environment, access to basic information about their rights, consent and confidentiality of patients, among others.

 A recent study carried out by Bonsu et al (1996) on user perception and assessment of quality of health care services provided at the Cape Coast hospital in the Central region of Ghana involving 320 users’ revealed factors which were considered most important in health care which includes availability of drugs, clinicians as well as equipments. The study also revealed that 57% of respondent were not informed of their diagnosis.

Clearly, the introduction of NHIS has open up access to health care. Many people who could not previously afford health services are now covered under the scheme.Consequently, the provision of service under the scheme have pushed service providers into high volume as a result of the number of people who report daily to access health care. It is in the light of this that the researcher decided to undertake this study to assess the level of customer satisfaction in health care delivery services at Tema General Hospital , a metropolitan hospital located in Community 9, Tema.

1.3 PURPOSE OF STUDY

The purpose of this study is to determine the perception of quality by NHIS clients on health care delivery, and evaluating patients’ satisfaction with the care provided at NHIS in Tema General Hospital.

1.4 OBJECTIVES OF THE STUDY

The main objective of the study was to assess the level of client satisfaction on the National Health Insurance Scheme.  Specifically, this research seeks to:

• Access the effectiveness and quality of the service provided
• Determine  the satisfaction of health services providers to insured and uninsured clients

• To find out the level of attention client with insurance are able to access during health care.

• To determine the adequacy of care provided to insured clients at Tema General Hospital clients on their treatment by their health service provider.
• To determine the adequacy of information given on their drugs and their conditions by health service provider.

1.5 RESEARCH QUESTIONS

In line with the objectives of the study answers would be found to the following questions

• What is the attitude and practices of health service providers toward insured clients?
• What is the relationship between patients and care givers?
• Are insured clients satisfied with the adequacy of services given?

1.6 METHODOLOGY

The investigation is going to take place at Tema General Hospital. The study will be conducted among people of TGH OPD (Out Patient Department). All persons (18 years and above) registered with the NHIS in the hospital who have accessed health care will form the study population.