Evaluating the Impact of the National Health Insurance Scheme of Ghana on Surgical Care

General Surgery, Costs and Cost Analysis Clinical Trial

Official title:

Evaluating the Impact of Health Insurance on Financial Risk Protection for Surgical Care: an Analysis of Ghana' Insurance Scheme at Korlebu Teaching Hospital

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03604458
• Other study ID #: D43TW009343
• Secondary ID: D43TW009343
• Status: Completed
• Start date: February 1, 2017
• Est. completion date: November 12, 2017

Study information

• Verified date: July 2018
• Source: University of California, San Francisco
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Ghana, a Low-Middle Income Country (LMIC) situated in the heart of West Africa started a national health insurance scheme in 2003.The scheme was designed to provide a comprehensive benefit package inclusive of surgical care and to protect against the need to pay out of pocket at the point of service. As of 2013, close to 40% of the population of Ghana was actively enrolled and ongoing plans to expand coverage by the government. This study tests the extent to which the national health insurance scheme of Ghana provides financial risk protection against catastrophic payments as a result of access to surgical care.

Description:

It is estimated that 11%-33% of the global burden of disease is attribute to surgical conditions. Yet, globally 3.7 billion people face financial catastrophe if surgical care is needed. Ghana, a country of 27 million people has a 14-year experience with a national health insurance scheme (NHIS) that provides coverage for 95% of the health conditions afflicting Ghanaians and includes access to surgical care. Despite much progress in providing Universal Health Coverage through NHIS, prior work shows that up to 18% of insured households make catastrophic health payments for routine care which is largely unaffordable for the poor. Particularly in Ghana where 1 out of 4 individuals live on less than 1.25 dollars per day. More importantly in 2015, the Lancet Commission on Global Surgery called for national surgical plans that provide 100% coverage against catastrophic health expenditures as a result of seeking surgical care.

The premise of Dr. Okoroh's GloCal project is to describe the surgical conditions that are included in the health insurance scheme and to evaluate whether insurance protect surgical patients against catastrophic health payments through a single institutional review at Korle-bu Teaching Hospital. With this work she hopes to develop a set of recommendations to the ministry of health and the national health insurance authority on how to improve health-care financing for surgical care in Ghana.

Early results of our study show that NHIS provides coverage for most common surgical conditions including symptomatic hernia, breast cancer, and appendicitis. 70% of the total cost of surgical care was covered by NHIS, yet 56% of insured individuals made catastrophic payments for surgical care. Surgery is unaffordable as on average insured individuals spent close to 40% of their annual income on surgical care. Particularly the coverage of medicines, supplies, imaging, and other ancillary services are sparse which are necessary to the provision of surgical care. Our recommendations include; NHIS increasing the proportion of the total cost of surgical care covered for the poor and addressing the gaps in coverage of ancillary services. Further work includes understanding how households economically cope with making payments and the contribution of borrowing and other financing mechanisms in reducing the burden of cost. Our new study characterizes the cost of trauma care which is a major source of disability and injury for young adults in Ghana. Efforts are being made to engage policymakers on healthcare reform in Ghana.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 203
• Est. completion date: November 12, 2017
• Est. primary completion date: October 1, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• All adult patients admitted to the general surgery ward between February 1st and October 1st 2017.

Exclusion Criteria:

• Patients treated on the subspecialty wards

• Individuals less than 18 years of age.

• If unable to provide informed consent

Related Conditions & MeSH terms

• General Surgery, Costs and Cost Analysis

Locations

Country	Name	City	State
Ghana	Korle-Bu Teaching Hospital	Accra

Sponsors (6)

Lead Sponsor	Collaborator
University of California, San Francisco	Brigham and Womens’ Hospital, Center for Surgery and Public Health, John E. Fogarty International Center (FIC), Office of Research on Women's Health (ORWH), UC Global Health Institute, University of California Global Health Institute - UCGloCal Program

Country where clinical trial is conducted

Ghana, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Out of Pocket Expenditure for Surgical Care	Out of pocket expenditure for surgical care is defined as all of the direct and indirect expenses incurred by an individual seeking surgical care at Korlebu Teaching Hospital during the study time period.	During the hospitalization or episode of surgical care (respondents are interviewed prior to discharge from the hospital, on average less than two weeks)
Secondary	Catastrophic Health Expenditure for Surgical Care	Catastrophic Health Expenditure for Surgical Care is defined as out of pocket expenditures which exceed 20% of the individual's income, 10% of the household expenditures, or 40% of net food expenditures	During the hospitalization or episode of surgical care (respondents are interviewed prior to discharge from the hospital, on average less than two weeks)