KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY, KUMASI
COMMONWEALTH EXECUTIVE MASTERS IN BUSINESS ADMINISTRATION.
TITLE OF RESEACH PROJECT: The Role of Auditing and its impact on the achievement of organizational objectives. Case study: National Health Insurance Scheme
1.1 BACKGROUND TO THE STUDY
As part of the Ghana’s Poverty Reduction Strategy(GPRS) ,the government has initiated a policy to deliver accessible, affordable,and good quality healthcare to all Ghanaians especially the poor and most vulnerable in society. The current out of pocket (cash and carry) payment for healthcare at the point of service delivery posses a financial barrier to health care access. It is estimated that out of 18% of the population who require health care at any given time, only 20% of them are able to access it. This means that about 80% of people living in Ghana who need healthcare cannot afford to pay out-of pocket at the point of service use. This has resulted in delays in seeking health care, non compliance to treatment and consequently premature death. Financing health care has gone through a chequered history in Ghana. Immediately after independence, health care provided to the people was “free” in public health facilities. This meant that there was no direct out-of pocket payment at the point of consumption of health care in public health facilities. Financing of health in the public sector was, therefore, entirely through tax revenue. The sustainability of this form of financing became questionable as the economy began to show signs of decline and there were competing demands on the same source. What is important to note was that the general tax revenue did not allow for a percentage earmarked for health as we now have in the case of a percentage of VAT earmarked for education. The trend continued until 1985 when the government introduced the user fees for all medical conditions except certain specified communicable diseases. The free health care policy was badly implemented in that although communicable diseases were supposed to have been exempted; in practice nobody enjoyed this facility. Also, a guideline for implementation was not provided. No conscious system was designed to prevent possible financial leakages.
In the ensuing years, the standard of health care provision fell drastically as a result. There was acute shortage of essential drugs in all public health facilities. Most importantly, the introduction of the user fees resulted in the first observed decline in utilization of health services in the country. In spite of this, the government went ahead to institute full cost recovery for drugs as a way of generating revenue to address the shortage of drugs. The payment mechanism put in place was the “cash and carry”. The implementation of the “Cash and Cash” compounded the utilization problem by creating a financial barrier to health care access especially the poor. To address this problem the government through an act of parliament, has initiated a national health insurance approach to financing health care. Ultimately, the vision of government in instituting a health insurance scheme in the country is to assure equitable and universal access for all residents to an acceptable quality package of essential health care. The policy objective is that within the next five years, every resident of Ghana shall belong to a health insurance scheme that adequately covers him or her against the need to pay out-of pocket at the point of service use in order to obtain access to a defined package of acceptable quality of healthcare service. It is to be emphasized that even though the national health insurance scheme is a humane substitute to the erstwhile “cash and carry” of health care delivery, the policy need to be sustained to meet the said objective as expected. For this to be achieved, the funds mobilized for this policy need to be utilized effectively. This when achieved will go a...
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