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Article ; Online: Policymakers' perspective on the importance of procedural fairness to implement and sustain health financing reforms.

González-Pier, Eduardo / Bryne, Inger Cathrine / Cárdenas Gamboa, Diana Isabel / Dsane-Selby, Lydia / Kapologwe, Ntuli / Radutskyi, Mykhailo / Sadanandan, Rajeev

Health policy and planning

2023 Volume 38, Issue Supplement_1, Page(s) i9–i12

Abstract: Fair process is instrumental to implementing and sustaining health financing reforms. Ensuring a fair process during the design and adoption phases can garner political capital and secure a sense of citizens' ownership. This will prove useful when ... ...

Abstract	Fair process is instrumental to implementing and sustaining health financing reforms. Ensuring a fair process during the design and adoption phases can garner political capital and secure a sense of citizens' ownership. This will prove useful when reforms are contested before benefits are yet to be fully materialized. Since many well devised health financing reforms are vulnerable to being dismantled after a few years of being launched, fair process should play a more strategic role in the implementation and evaluation phases when policies get challenged and reformulated to reflect the changing political and socioeconomic landscapes and to better manage early evidence on performance.
MeSH term(s)	Humans ; Health Care Reform ; Healthcare Financing
Language	English
Publishing date	2023-11-14
Publishing country	England
Document type	Journal Article
ZDB-ID	632896-9
ISSN	1460-2237 ; 0268-1080
ISSN (online)	1460-2237
ISSN	0268-1080
DOI	10.1093/heapol/czad064
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Book: Ghana national health insurance scheme

Wang, Huihui / Dsane-Selby, Lydia / Otoo, Nathaniel

improving financial fustainability based on expenditure review

(A World Bank study)

2017

Author's details	Huihui Wang, Nathaniel Otoo, and Lydia Dsane-Selby
Series title	A World Bank study
Keywords	Gesetzliche Krankenversicherung ; Ghana
Language	English
Size	53 Seiten, Illustrationen
Publisher	World Bank Group
Publishing place	Washington
Document type	Book
ISBN	9781464811173 ; 1464811172
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Article ; Online: Prevalence and quality of antihypertensive therapy among hypertension patients enrolled in the Ghana National Health Insurance Scheme.

Donneyong, Macarius M / Chang, Teng-Jen / Pottegård, Anton / Ankrah, Daniel / Asenso-Boadi, Francis / Addo-Cobbiah, Vivian / Dsane-Selby, Lydia / Hallas, Jesper

Pharmacoepidemiology and drug safety

2021 Volume 30, Issue 11, Page(s) 1566–1575

Abstract: Background: Hypertension is a leading cause of morbidity in Ghana. However, there is insufficient data on the prevalence and quality of antihypertensive therapy.: Objectives: To describe the prevalence of use and quality of antihypertensive therapy.!# ...

Abstract	Background: Hypertension is a leading cause of morbidity in Ghana. However, there is insufficient data on the prevalence and quality of antihypertensive therapy. Objectives: To describe the prevalence of use and quality of antihypertensive therapy. Methods: A cross-sectional study design was used to analyze the 2015 Ghana National Health Insurance Scheme (NHIS) electronic claims data. Hypertension diagnosis was defined using ICD-10 codes. The primary outcomes assessed were the prevalence of use and quality of antihypertensive therapy. Quality of antihypertensive therapy was defined as the use of antihypertensive agents recommended for treating hypertension patients with comorbid heart failure, myocardial Infarction/Coronary Artery Disease, diabetes, chronic kidney disease or stroke. We used multivariable logistic regression models to identify predictors of antihypertensive use and quality of therapy. Results: Antihypertensive medication use was very high (86%) among the 161 873 hypertension patients covered under the Ghana NHIS. Only a third (32%) of hypertension patients received guideline-concordant therapy. Angiotensin receptor blockers were consumed at the highest dosages of 120 (Interquartile Range [IQR]: 60, 180) daily defined doses over a year. Males (odds ratio [OR] = 0.60; 95% Confidence Interval [CI]:0.58, 0.61) and those with comorbid stroke (OR = 0.91, 95% CI:0.84, 0.99), diabetes (OR = 0.72; 95% CI:0.69, 0.74) and stroke (OR = 0.74, 95%CI:0.68, 0.80) were less likely to use antihypertensives, all other predictors were associated with higher use. Conclusion: Antihypertensive medication use was very high among hypertension patients covered under the Ghana NHIS. However, there was indication of suboptimal quality of the antihypertensive therapy provided.
MeSH term(s)	Antihypertensive Agents/therapeutic use ; Cross-Sectional Studies ; Ghana/epidemiology ; Humans ; Hypertension/drug therapy ; Hypertension/epidemiology ; Insurance, Health ; Male ; National Health Programs ; Prevalence
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2021-06-16
Publishing country	England
Document type	Journal Article
ZDB-ID	1099748-9
ISSN	1099-1557 ; 1053-8569
ISSN (online)	1099-1557
ISSN	1053-8569
DOI	10.1002/pds.5298
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Article ; Online: What do we need to know? Data sources to support evidence-based decisions using health technology assessment in Ghana.

Hollingworth, Samantha A / Downey, Laura / Ruiz, Francis J / Odame, Emmanuel / Dsane-Selby, Lydia / Gyansa-Lutterodt, Martha / Nonvignon, Justice / Chalkidou, Kalipso

Health research policy and systems

2020 Volume 18, Issue 1, Page(s) 41

Abstract: Background: Evidence-based decision-making for prioritising health is assisted by health technology assessment (HTA) to integrate data on effectiveness, costs and equity to support transparent decisions. Ghana is moving towards universal health coverage, ...

Abstract	Background: Evidence-based decision-making for prioritising health is assisted by health technology assessment (HTA) to integrate data on effectiveness, costs and equity to support transparent decisions. Ghana is moving towards universal health coverage, facilitated mainly by the National Health Insurance Scheme (NHIS) established in 2003. The Government of Ghana is committed to institutionalising HTA for priority-setting. We aimed to identify and describe the sources of accessible data to support HTA in Ghana. Methods: We identified and described data sources encompassing six main domains using an existing framework. The domains were epidemiology, clinical efficacy, costs, health service use and consumption, quality of life, and equity. We used existing knowledge, views of stakeholders, and searches of the literature and internet. Results: The data sources for each of the six domains vary in extent and quality. Ghana has several large data sources to support HTA (e.g. Demographic Health Surveys) that have rigorous quality assurance processes. Few accessible data sources were available for costs and resource utilisation. The NHIS is a potentially rich source of data on resource use and costs but there are some limits on access. There are some data on equity but data on quality of life are limited. Conclusions: A small number of quality data sources are available in Ghana but there are some gaps with respect to HTA based on greater use of local and contextualised information. Although more data are becoming available for monitoring, challenges remain in terms of their usefulness for HTA, and some information may not be available in disaggregated form to enable specific analyses. We support recent initiatives for the routine collection of comprehensive and reliable data that is easily accessible for HTA users. A commitment to HTA will require concerted efforts to leverage existing data sources, for example, from the NHIS, and develop and maintain new data (e.g. local health utility estimates). It will be critical that an overarching strategic and mandatory approach to the collection and use of health information is developed for Ghana in parallel to, and informed by, the development of HTA approaches to support resource allocation decisions. The key to HTA is to use the best available data while being open about its limitations and the impact on uncertainty.
MeSH term(s)	Ghana ; Health Services ; Humans ; Information Storage and Retrieval ; Learning Health System ; National Health Programs/economics ; Quality of Life ; Resource Allocation ; Technology Assessment, Biomedical/methods ; Universal Health Insurance
Language	English
Publishing date	2020-04-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2101196-5
ISSN	1478-4505 ; 1478-4505
ISSN (online)	1478-4505
ISSN	1478-4505
DOI	10.1186/s12961-020-00550-8
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Article ; Online: A review of the Ghana National Health Insurance Scheme claims database: possibilities and limits for drug utilization research.

Ankrah, Daniel / Hallas, Jesper / Odei, James / Asenso-Boadi, Francis / Dsane-Selby, Lydia / Donneyong, Macarius

Basic & clinical pharmacology & toxicology

2018 Volume 124, Issue 1, Page(s) 18–27

Abstract: Background: There are inadequate data on prescribed drug utilization in Sub-Saharan Africa (SSA). Drug utilization research (DUR) in this region is hampered by lack of access to databases that capture prescribed drug utilization such as health insurance ...

Abstract	Background: There are inadequate data on prescribed drug utilization in Sub-Saharan Africa (SSA). Drug utilization research (DUR) in this region is hampered by lack of access to databases that capture prescribed drug utilization such as health insurance claims, electronic medical records and disease registries. The primary objective of this MiniReview was to describe the content of the NHIS claims database in the context of the health care system in Ghana. We will also review the possibilities and limitations of analysing this novel database for drug utilization research (DUR) in Ghana. Methods: We reviewed the history, composition of the database, coverage and health systems in Ghana. To demonstrate the application of the NHIS claims database for DUR, we reviewed the NHIS' drug formulary (NHIS medicines' list), assessed and quantified the utilization of the top 25 most commonly prescribed medicines and their distributions by age, sex, region of residence and by MDCs. Results: As of December 2014, about 40% (~10.5 million) of the Ghanaian population were active beneficiaries of NHIS. There were 1.43 million unique patients in the NHIS claims database who received services from about 81 providers located in 9 out of the 10 regions in Ghana. The mean age of this sample of beneficiaries was 31 (standard deviation, 22) years, a third of whom were aged <18 years old. Nearly, 2 out of every 3 beneficiaries were females. On average, there were approximately 3 outpatient visits per beneficiary in 2015. There were about 522 unique drugs on the NHIS medicine list. Overall, analgesic was the most prescribed class of medicine (mostly paracetamol and diclofenac). Antimalarials, artemether-lumefantrine, were observed as the second most prescribed medicines followed by anti-infectives (metronidazole) and antihypertensives (amlodipine). Conclusion: The Ghana NHIS claims database is a great resource for DUR. This database could also be extended to facilitate pharmacoepidemiological and other health services' research especially if transformed into one of the existing standardized common data models.
MeSH term(s)	Databases, Factual/statistics & numerical data ; Drug Prescriptions/statistics & numerical data ; Drug Utilization Review/methods ; Drug Utilization Review/statistics & numerical data ; Ghana ; Humans ; Insurance Claim Review/statistics & numerical data ; National Health Programs/statistics & numerical data
Language	English
Publishing date	2018-10-31
Publishing country	England
Document type	Evaluation Studies ; Journal Article ; Review
ZDB-ID	2134679-3
ISSN	1742-7843 ; 1742-7835
ISSN (online)	1742-7843
ISSN	1742-7835
DOI	10.1111/bcpt.13136
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Article ; Online: Implementing health technology assessment in Ghana to support universal health coverage: building relationships that focus on people, policy, and process.

Hollingworth, Samantha / Gyansa-Lutterodt, Martha / Dsane-Selby, Lydia / Nonvignon, Justice / Lopert, Ruth / Gad, Mohamed / Ruiz, Francis / Tunis, Sean / Chalkidou, Kalipso

International journal of technology assessment in health care

2019 Volume 36, Issue 1, Page(s) 8–11

Abstract: Ghana is one of the few African countries to enact legislation and earmark significant funding to establish universal health coverage (UHC) through the National Health Insurance Scheme, although donor funds have declined recently. Given a ... ...

Abstract	Ghana is one of the few African countries to enact legislation and earmark significant funding to establish universal health coverage (UHC) through the National Health Insurance Scheme, although donor funds have declined recently. Given a disproportionate level of spending on medicines, health technology assessment (HTA) can support resource allocation decisions in the face of highly constrained budgets, as commonly found in low-resource settings. The Ghanaian Ministry of Health, supported by the International Decision Support Initiative (iDSI), initiated a HTA study in 2016 to examine the cost-effectiveness of antihypertensive medicines. We aimed to summarize key insights from this work that highlights success factors beyond producing purely technical outputs. These include the need for capacity building, academic collaboration, and ongoing partnerships with a broad range of experts and stakeholders. By building on this HTA study, and with ongoing interactions with iDSI, HTAi, WHO, and others, Ghana will be well positioned to institutionalize HTA in resource allocation decisions and support progress toward UHC.
MeSH term(s)	Antihypertensive Agents/economics ; Antihypertensive Agents/therapeutic use ; Capacity Building/organization & administration ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Ghana ; Health Care Rationing/organization & administration ; Health Policy ; Humans ; Hypertension/drug therapy ; Technology Assessment, Biomedical/organization & administration ; Universal Health Insurance/economics ; Universal Health Insurance/organization & administration
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2019-11-28
Publishing country	England
Document type	Journal Article
ZDB-ID	632573-7
ISSN	1471-6348 ; 0266-4623
ISSN (online)	1471-6348
ISSN	0266-4623
DOI	10.1017/S0266462319000795
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Article ; Online: Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review.

Okoroh, Juliet / Essoun, Samuel / Seddoh, Anthony / Harris, Hobart / Weissman, Joel S / Dsane-Selby, Lydia / Riviello, Robert

BMC health services research

2018 Volume 18, Issue 1, Page(s) 426

Abstract: Background: Approximately 150 million people suffer from financial catastrophe annually because of out-of-pocket expenditures (OOPEs) on health. Although the National Health Insurance Scheme (NHIS) of Ghana was designed to promote universal health ... ...

Abstract	Background: Approximately 150 million people suffer from financial catastrophe annually because of out-of-pocket expenditures (OOPEs) on health. Although the National Health Insurance Scheme (NHIS) of Ghana was designed to promote universal health coverage, OOPEs as a proportion of total health expenditures remains elevated at 26%, exceeding the WHO's recommendations of less than 15-20%. To determine whether enrollment in the NHIS reduces the likelihood of OOPEs and catastrophic health expenditures (CHEs) in Ghana, we undertook a systematic review of the published literature. Methods: We searched for quantitative articles published in English between January 1, 2003 and August 22, 2017 in PubMed, Google Scholar, Economic Literature, Global Health, PAIS International, and African Index Medicus. Two independent authors (J.S.O. & S.E.) reviewed the articles for inclusion, extracted the data, and conducted a quality assessment of the studies. We accepted the World Health Organization definition of catastrophic health expenditures which is out of pocket payments for health care which exceeds 20% of annual house hold income, 10% of household expenditures, or 40% of subsistence expenditures (total household expenditures net food expenditures). Results: Of the 1094 articles initially identified, 7 were eligible for inclusion. These were cross-sectional household studies published between 2008 and 2016 in Ghana. They demonstrated that the uninsured paid 1.4 to 10 times more in out-of-pocket payments (OOPs) and were more likely to incur CHEs than the insured. Yet, 6 to 18% of insured households made catastrophic payments for healthcare and all studies reported insured members making OOPs for medicines. Conclusion: Evidence suggests that the national health insurance scheme of Ghana over the last 14 years has made some impact on reducing OOPEs, and yet healthcare costs remain catastrophic for a large proportion of insured households in Ghana. Future studies need to explore reasons for the persistence of OOPs for medicines and services that are covered under the scheme.
MeSH term(s)	Cross-Sectional Studies ; Delivery of Health Care/economics ; Delivery of Health Care/statistics & numerical data ; Ghana/epidemiology ; Health Expenditures ; Humans ; Insurance Coverage/economics ; Medically Uninsured/statistics & numerical data ; National Health Programs/economics ; National Health Programs/statistics & numerical data
Language	English
Publishing date	2018-06-07
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-018-3249-9
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Article ; Online: Reducing medical claims cost to Ghana's National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews.

Nsiah-Boateng, Eric / Asenso-Boadi, Francis / Dsane-Selby, Lydia / Andoh-Adjei, Francis-Xavier / Otoo, Nathaniel / Akweongo, Patricia / Aikins, Moses

BMC health services research

2017 Volume 17, Issue 1, Page(s) 115

Abstract: Background: A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews ... ...

Abstract	Background: A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. Methods: The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews. Results: The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p < 0.001). However, there were no significant differences in claims cost adjustment rate between healthcare facility types by the electronic-based (p = 0.0656) and by the paper-based reviews (p = 0.6484). Conclusions: The electronic-based review adjusted significantly higher claims cost than the paper-based claims review. Scaling up the electronic-based review to cover claims from all accredited care providers could reduce spurious claims cost to the scheme and ensure long term financial sustainability.
MeSH term(s)	Cost Savings ; Cross-Sectional Studies ; Electronic Health Records ; Fraud ; Ghana ; Health Facilities ; Humans ; Insurance Claim Review/economics ; Insurance, Health/statistics & numerical data ; National Health Programs/economics ; Paper
Language	English
Publishing date	2017-02-06
Publishing country	England
Document type	Comparative Study ; Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-017-2054-1
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