Health care financing and sustainability: A study of current conceptual dialectics in Ghana

One major challenge in health policy and planning in third world countries is the sustainability of publicly funded health insurance schemes. Economic renegence restricts the fiscal capacity of governments in Ghana to allocate limited public funds to financing a public sponsored health care insurance scheme. In the intervening time, the increasing demands within populations in the country for health care continue to escalate amidst political campaigns to increase access in health care and to motion towards universalism. General health care demands for the population grow as cost of treatment and enrolment increase resulting in sustainability issues; which are further perpetuated by institutional ineptitudes, limited public funds and managerial lapses. This study examines the current conceptual debates in Ghana on the funding and sustainability of the National Health Insurance Scheme (NHIS). Using data from public fora, interviews, conferences, newspapers, workshops, television and radio discussions and parliamentary Hansards and manuscripts, the study revealed that as part of the public policy making process the current debate is generally influenced by stakeholders' interest, power and solidarity even though there are attempts in some quarters to make political capital out of the debate. The complex relationship among the various stakeholders has stimulated an unabated discourse which has caused most of the stakeholders to adopt staunch positions in the debate.