| dc.description.abstract | Despite impressive progress since 2003, huge challenges remain in the effort to improve health outcomes in Ghana and achieve related goals concerning universal coverage, basic needs, equity, inclusion, risk protection and reaching poor and marginalized groups. One of these challenges is how health should be financed – who should pay how much and through what arrangements, given the reality that the services and other actions needed to attain desired health results inevitably involve costs that must be financed somehow. Ghana's National Health Insurance Scheme (NHIS) has not achieved full population coverage although it is a social health insurance scheme. The introduction of the scheme was in response to the plight of the poor who are faced with catastrophic health care expenditures whenever they needed medical attention. This study, in relation to other studies on the problems and challenges of the NHIS, identifies socio-economic factors as the most pressing challenges faced by service providers and the receivers of these services (subscribers and non-subscribers). This is, however, not mutually exclusive as other significant non-economic challenges of the NHIS are a part of the reasons why the NHIS has failed to reach full population coverage. The study adopts decision-making theories which influences the demand of NHIS by the population together with theories of health care provisioning in the health insurance context. Secondary literature detailing some problems and challenges of social health insurance from different perspectives and countries were also explored. This together with the theories formed the main theoretical and conceptual perspectives against which informants’ opinions were examined. It is revealed that the problems and challenges of the NHIS include extra charges or fees, decline in the quality of services, shortages of essential drugs, delays and deliberate manipulation of the scheme, limited access to information and health facilities, delays in claims reimbursement, price fluctuations of drugs and medical supplies, geographical barriers, the large informal sector population, multiple health seeking behaviour of subscribers, amongst others. These problems and challenges affects the decisions making of people to enrol or not. It also influences the quality and type of services that service providers are willing and able to offer. The study documents claim reimbursement as representing the greatest challenge. I recommend structural adjustments to the scheme and possibly the introduction of a tax based system alongside the social insurance to make more resources available for the operations of the scheme to achieve equity and equitable access to universal health care. | eng |