Background: Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring\nmore equitable financing of health care to improve access to health services. This qualitative study examines the\nchallenges and consequences of medicines management policies and practices under the NHIS as perceived by\npublic and private service providers.\nMethods: This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana\nbetween July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of\npublic and private sector providers (government and mission hospitals, private hospitals and private standalone\npharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview\nguides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of\nmedicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and\nalso in response to themes that emerged from the transcripts and notes.\nResults: Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by\nremoving cost barriers for patients; however, some pointed out the increased utilization could also be corollary to\nmoral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low\nreimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs\nreported important differences between private and public sectors including weak separation of prescribing and\ndispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects\nof unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers\n(especially pharmacies and licensed chemical sellers) in the NHIS.\nConclusions: Health providers generally perceive the NHIS to have had a largely positive impact on access to\nmedicines. However, concerns remain about equity in access to medicines and the differences in quality of\npharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the\nimplementation of health insurance schemes is important to identify and address the potential consequences of\nmedicines policies and practices under the scheme.
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