Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach.

BACKGROUND: Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. METHODS: A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. RESULTS: There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. CONCLUSIONS: As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects.

Taking Stock of Policies, Regulations, and Initiatives That Leverage Technology to Build Trust: Lessons from Ghana's Financial Sector.

Technological innovations that increase trust in the financial sector can drive financial growth. Using Ghana as a case study, this study reviewed technology-focused policies, strategy documents, and peer-reviewed literature to assess how financial technology is being utilized to build trust in financial institutions. The literature search revealed that two categories of technological applications are being used to build trust: payment platforms and trade and investment technologies. The findings showed that Ghana has adopted wide-ranging initiatives to build trust-for example, the National Digital Property Addressing System, the Re-registration of SIM Cards, and the passage of the Data Protection Act (Act 843 of 2012). We also identified key challenges associated with leveraging technologies in the sector. Valuable for financial institutions, academics, practitioners, and other financial-sector actors, the insights from this study could enhance policy formulation and implementation across other jurisdictions.

Balancing equity and efficiency in health priorities in Ghana: the use of multicriteria decision analysis.

OBJECTIVES: To guide the Ministry of Health in Ghana in the priority setting of interventions by quantifying the trade-off between equity, efficiency, and other societal concerns in health. METHODS: The study applied a multicriteria decision analytical framework. A focus group of seven policymakers identified the relevant criteria for priority setting and 63 policymakers participated in a discrete choice experiment to weigh their relative importance. Regression analysis was used to rank order a set of health interventions on the basis of these criteria and associated weights. RESULTS: Policymakers in Ghana consider targeting of vulnerable populations and cost-effectiveness as the most important criteria for priority setting of interventions, followed by severity of disease, number of beneficiaries, and diseases of the poor. This translates into a general preference for interventions in child health, reproductive health, and communicable diseases. CONCLUSION: Study results correspond with the overall vision of the Ministry of Health in Ghana, and are instrumental in the assessment of present and future investments in health. Multicriteria decision analysis contributes to transparency and accountability in policymaking.