Effects of consumer and provider moral hazard at a municipal hospital out-patient department on Ghana's National Health Insurance Scheme.

BACKGROUND: In 2003, Ghana introduced the national health insurance scheme (NHIS) to promote access to healthcare. This study determines consumer and provider factors which most influence the NHIS at a municipal health facility in Ghana. METHOD: This is an analytical cross-sectional study at the Winneba Municipal Hospital (WHM) in Ghana between January-March 2010. A total of 170 insured and 175 uninsured out-patients were interviewed and information extracted from their folders using a questionnaire. Consumers were from both the urban and rural areas of the municipality. RESULTS: The mean number of visits by insured consumers to a health facility in previous six months was 2.48 +/- 1.007 and that for uninsured consumers was 1.18 +/- 0.387(p-value<0.001). Insured consumers visited the health facility at significantly more frequent intervals than uninsured consumers (χ(2) = 55.413, p-value< 0.001). Overall, insured consumers received more different types of medications for similar disease conditions and more laboratory tests per visit than the uninsured. In treating malaria (commonest condition seen), providers added multivitamins, haematinics, vitamin C and intramuscular injections as additional medications more for insured consumers than for uninsured consumers. CONCLUSION: Findings suggest consumer and provider moral hazard may be two critical factors affecting the NHIS in the Effutu Municipality. These have implications for the optimal functioning of the NHIS and may affect long-term sustainability of NHIS in the municipality. Further studies to quantify financial/ economic cost to NHIS arising from moral hazard, will be of immense benefit to the optimal functioning of the NHIS.

Sensitivity test on Neisseria meningitidis strains to antimicrobial drugs.

1. The Authors present the antibiotic sensitivity pattern of 62 Neisseria meningitidis strains isolated in Northern Ghana (Bawku, Navrongo, Bolgatanga and Nalerigu) in February-March, 1973. The following antibiotics or chemotherapeutic drugs were effective in vitro: Penicillin 100%, Ampicillin 100%, Chloramphenicol 100%, Tetracycline 100%, Erythromycin 100% (Nalidixic acid 100%, Nitrofurantion 100%), and the following were less effective: Streptomycin 61.2%, Novobiocin 100% (weakly sensitive), Oleandomycin 95.1% (weakly sensitive), Septrin 87%, Sulphafurazole 91.9%, Sulphadiazine 91.9%. All the isolates were Colistin resistant. 2. The sex and age distribution of patients with positive culture for Neisseria meningitidis shows the preponderance of males over females and the dominance of the group of 5-15 years of age over the other age groups. These results are in good agreement with previous data collected in other countries of the "meningitis belt".