Research by a nine-member team of the University of Health and Allied Sciences (UHAS), in collaboration with the Ghana Health Service (GHS), has revealed that informal and out-of-pocket patient payments existed within the formal health care system.
The Team said the payments were usually to obtain better attention, care or to avoid delay at the health facility.
It showed that the payments disproportionately favoured only those who had the capacity or ability to pay for services to the disadvantage of the relatively poorer elderly people.
Dr Martin Ayanore of UHAS and Principal Investigator of the Research, addressing participants during a virtual dissemination workshop, said the factors that determined the payments at health facilities were largely individual and household driven.
The findings were from a recently ended study titled: “Informal patient payments within the formal health system among older persons (60+ years) in three health facilities in the Volta Region: Policy implications for health care financing and geriatric care.”
The project, funded by the University of Health and Allied Sciences, formed part of the University’s mandate to disseminate knowledge and the results of research and their applications to the needs and aspirations of the people.
The two-year research was conducted in three sites in the Volta Region; namely Hohoe and Ho Municipals and Keta District.
Dr Ayanore said a significant proportion of the elderly could not make informal payments as a result of their present financial circumstances.
He said the proportion of informal payments for in-patient care was higher relative to out-patient care services received by the elderly in the study settings.
He said although the ability to offer informal patient payments was low, there was a high willingness to pay expression by respondents.
The Principal Investigator said specific services, drugs and disease conditions not covered under health insurance, delays in reimbursing facilities, need to keep services running and lack of well-developed policy on out-of-pocket payments were reasons for the practice.
He noted that informal patient payments also existed because of personal gains of some health workers, shortage of essential medicines which created opportunities for some health staff to seek them to clients and the government’s non-payment of utility bills, which forced managers to find alternative ways to settle expenses.
Dr Ayanore noted that the charging of user fees, poverty among the elderly hindering payment of renewal fees, unclear message about the National Health Insurance Scheme and the aged not being aware of their cards being missing or expired were challenges with the implementation of the “Exemption Policy.”
He said effects of the payments on service utilisation and Universal Health Coverage (UHC) include disruption of the medication and care continuum of the elderly due to constant demand for out-of-pocket payments and weakening of health behaviour among the elderly.
Dr Ayanore said it also led to high health expenditure, retard progress towards UHC and lead to health inequity because quality health care only went in favour of those who could pay for all the services.
He said the present problem required urgent policy action to protect economically vulnerable older people from financial catastrophe and contribute to UHC in Ghana.
The Principal Investigator recommended the reorientation of the current health care financial model at the national level in line with the attainment of UHC.
Dr Ayanore tasked the Ministry of Health and the Ghana Health Service to work towards regular restocking of pharmacies and dispensaries to prevent shortages that led to unauthorised selling of essential drugs by some health workers in exchange for informal cash payments.
He also called for public education regarding official user fees and health insurance in an appealing and understandable form, especially for the elderly and less educated.
Concerning knowledge, attitudes and perceptions regarding informal payments, most respondents had a positive attitude towards informal payments while most also did not know where to complain.
Most respondents also strongly disagreed that informal payments were similar to corruption but gifts to express gratitude.
Madam Josephine Asante, a representative from the Ghana Health Service (GHS), participating in the meeting, revealed that there was a Department within the Family Health Division of the GHS with a National Coordinator who coordinated affairs of the geriatrics.
She said there were proposals to develop guidelines that would help the Department to enhance its work.
Mr Fidelis Anumu, Research Operations Office, Institute of Health Research, UHAS, noted that the conduct of research was a key element of the vision of the University.
He said the research fund was to build the capacity of faculty, build capacity in research grants management and also build capacity in the ability to respond to calls for proposals and in submitting applications for international competitive grants.
Mr Anumu said a total of GH¢418,523.32 worth of grants were awarded to 25 senior members of the University for various research projects.
Participants invited for the workshop included representatives from District and the Regional Health Directorates, elderly persons from Hohoe, Ho and Keta, groups from the academia, district representative from the National Health Insurance Authority (NHIA), Civil Society Organisation and NGOs in Health, members of the academic community, Ghana Health Service (National) and the media.