title: Effects of consumer and provider moral hazard at a municipal hospital out-patient department on Ghana's National Health Insurance Scheme.
abstract: BACKGROUND
  In 2003, Ghana introduced the national health insurance scheme (NHIS) to promote access to healthcare. This study determines consumer and provider factors which most influence the NHIS at a municipal health facility in Ghana.
  
  
  METHODS
  This is an analytical cross-sectional study at the Winneba Municipal Hospital (WHM) in Ghana between January-March 2010. A total of 170 insured and 175 uninsured out-patients were interviewed and information extracted from their folders using a questionnaire. Consumers were from both the urban and rural areas of the municipality.
  
  
  RESULTS
  The mean number of visits by insured consumers to a health facility in previous six months was 2.48 +/- 1.007 and that for uninsured consumers was 1.18 +/- 0.387(p-value<0.001). Insured consumers visited the health facility at significantly more frequent intervals than uninsured consumers (χ(2) = 55.413, p-value< 0.001). Overall, insured consumers received more different types of medications for similar disease conditions and more laboratory tests per visit than the uninsured. In treating malaria (commonest condition seen), providers added multivitamins, haematinics, vitamin C and intramuscular injections as additional medications more for insured consumers than for uninsured consumers.
  
  
  CONCLUSIONS
  Findings suggest consumer and provider moral hazard may be two critical factors affecting the NHIS in the Effutu Municipality. These have implications for the optimal functioning of the NHIS and may affect long-term sustainability of NHIS in the municipality. Further studies to quantify financial/ economic cost to NHIS arising from moral hazard, will be of immense benefit to the optimal functioning of the NHIS.
authors: Department of Community Health, University of Ghana Medical School, College of Health Sciences, Korle-Bu, Accra, Ghana. aeyawson@yahoo.com
authors: A E
authors: AE
authors: Yawson
authors: R B
authors: RB
authors: Biritwum
authors: P K
authors: PK
authors: Nimo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005869:Ghana; D006773:Hospitals, Municipal / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D028681:Moral Obligations; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Ghana; Social health insurance; consumer moral hazard and provider moral hazard; low-income countries
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