Risk management and insurance failures: the case of Ghana’s National Health Insurance Scheme

Since its inception, Ghana’s National Health Insurance Scheme (NHIS) has brought about notable improvements in healthcare access and health outcomes. However, challenges have arisen, threatening its intended function. This study aims to investigate the challenges encountered by NHIS participants and their risk management practices in response to insurance failures. Convenience and purposeful sampling techniques were employed to gather data from 45 Quality Insurance Company (QIC) employees residing in the Greater Accra area of Ghana who are NHIS members. A quantitative approach was utilized, and a questionnaire was administered to collect data. The study employed Cronbach’s alpha to assess the reliability and validity of the data. Additionally, Regression analysis, correlation, and descriptive statistics were utilized to achieve the study's objectives. The study revealed several challenges facing the NHIS, including a shortage of medical specialists, medications, and hospital beds, as well as high patient out-of-pocket expenses. Despite these challenges, the NHIS has not yet failed. However, the majority of NHIS cardholders (62.20%) would be adversely affected in the event of system failure, as they primarily rely on NHIS for risk management. Conversely, a minority of participants (37.80%) are less likely to experience the effects of failure due to alternative insurance plans and personal savings. Therefore, understanding these dynamics is crucial for policymakers and stakeholders to strengthen the NHIS and ensure sustainable healthcare access for all Ghanaians.