title: Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District.
abstract: BACKGROUND
  Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to provide financial access to health care for all residents.
  
  
  OBJECTIVE
  This article analyzed claims reimbursement data of the NHIS to assess the value of the benefit package to the insured and responsiveness of the service to the financial needs of health services providers.
  
  
  METHODS
  Medical claims data reported between January 1, 2010, and December 31, 2014, were retrieved from the database of Ashiedu Keteke District Office of the National Health Insurance Authority. The incurred claims ratio, promptness of claims settlements, and claims adjustment rate were analyzed over the 5-year period.
  
  
  RESULTS
  In all, 644,663 medical claims with a cost of Ghana cedi (GHS) 11.8 million (US $3.1 million) were reported over the study period. The ratio of claims cost to contributions paid increased from 4.3 to 7.2 over the 2011-2013 period, and dropped to 5.0 in 2014. The proportion of claims settled beyond 90 days also increased from 26% to 100% between 2011 and 2014. Generally, the amount of claims adjusted was low; however, it increased consistently from 1% to about 4% over the 2011-2014 period. The reasons for claims adjustments included provision of services to ineligible members, overbilling of services, and misapplication of diagnosis related groups.
  
  
  CONCLUSIONS
  There is increased value of the NHIS benefit package to subscribers; however, the scheme's responsiveness to the financial needs of health services providers is low. This calls for a review of the NHIS policy to improve financial viability and service quality.
authors.affiliation: Research, Policy, Monitoring & Evaluation Directorate, National Health Insurance Authority, Accra, Ghana. Electronic address: nsiahboateng@gmail.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Nsiah-Boateng
authors.affiliation: Health Policy, Planning and Management Department, School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Moses
authors.initials: M
authors.lastname: Aikins
authors.affiliation: Research, Policy, Monitoring & Evaluation Directorate, National Health Insurance Authority, Accra, Ghana.
authors.forename: Francis
authors.initials: F
authors.lastname: Asenso-Boadi
authors.affiliation: Research, Policy, Monitoring & Evaluation Directorate, National Health Insurance Authority, Accra, Ghana; Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Francis-Xavier
authors.initials: FX
authors.lastname: Andoh-Adjei
mesh_terms: D003695:Delivery of Health Care; D003953:Diagnosis-Related Groups; D005869:Ghana; D006291:Health Policy; D006297:Health Services Accessibility; D007341:Insurance; D007348:Insurance, Health; D009313:National Health Programs
keywords: Ghana; National Health Insurance Scheme; claims ratio; claims reimbursement; service quality