Table 2 Perspectives of... | Emerald Publishing

Table 2

Perspectives of implementers/health service providers

Factors	Health policy implementers perspectives
Referrals	The referral system of GHS aims to increase subscribers’ and other clients’ access to drugs and services and part of the process towards health facilities access and quality assurance measures (I: MHO1). Referrals are often from a lower health facility to a higher one example from a primary facility to a secondary and a tertiary facility like TTH or Komfo Anokye or Korle Bu teaching hospitals (I: SO3).
Effectiveness in monitoring	We are not able to get full cooperation from facilities in areas of right prescriptions, early submission of claims and collection of cheques, continuous monitoring of facilities to ensure good, quality health services for subscribers are also a problem (I: SO3). You know this clinic is not for GHS, so they do not control us, we did not obtain our license from GHS but PHMHB. What matters most is that we have a license to provide health care and we are always ready to provide quality services to our clients. We got our accreditation license from the health insurance authority, but they do not control us on what services to provide and whatnot (I: PRC2).
Timeliness	There is the need to reduce the time subscribers spend at our offices through our decentralised registration system, we also make efforts to pay facilities claims on time towards quality service delivery (I: SO3). We treat patients equally whether health insurance subscribers or those who pay cash, we provide prompt services in terms of medical consultation or drug prescription, and where we cannot meet the healthcare needs of patients, we refer them to higher facilities (I: PUC2) The health care needs of subscribers are important to us and we always try our possible best not to delay their time at the facility. Above all, we provide them with good quality services (I: PRC2)
Efficiency	…we do not vacate facility early as most clinics do. Moreover, the provision of quality service to subscribers is our topmost priority here (I: PRC1-5#2)
Reimbursement	There are too many delays in payments of claims, where you provide services to insurance members for eight months without reimbursement, how.... (I: PRC1-3#3) Health insurance is good, but reimbursement is the problem. Too many delays, no payments for the whole year (from January to July). (I: PUC1-3#1)
Compliance with standard guidelines of GHS	Health facilities work within GHS treatment guidelines be it public or private facilities to ensure that the quality of health services is not compromised (I: MHO1). Health insurance officials are involved in periodic monitoring of facilities service delivery across the country (I: NIO1).
Accreditation process	We receive credentials of facilities forward them to the authority for approval. NHIA accreditation body or delegated persons can make unannounced visits to inspect facilities to ensure standards are not compromised (I: SO3). We have a strict procedure that facilities must meet for accreditation and there is no favouritism, politics, or cronyism. Some service providers when they are denied accreditation, turn to blame us on these issues instead of doing the right thing. All that is expected is for the facility to meet the basic requirements of providing at least five core areas and meet the 50% pass mark (I: RIO1). This is a big hospital and has been able to meet all the conditions required for accreditation. Meeting conditions spelt out by NHIA is not a problem in this facility but maintaining standards and upgrading to secondary care hospital is our priority (I: PUH1, 3#1). We met those conditions set for facilities and have since been accredited and have renewed many times. The goal of the hospital is to become the best hospital in the metropolis (I: PRH1, 3#3).

Factors	Health policy implementers perspectives
Referrals	The referral system of GHS aims to increase subscribers’ and other clients’ access to drugs and services and part of the process towards health facilities access and quality assurance measures (I: MHO1).Referrals are often from a lower health facility to a higher one example from a primary facility to a secondary and a tertiary facility like TTH or Komfo Anokye or Korle Bu teaching hospitals (I: SO3).
Effectiveness in monitoring	We are not able to get full cooperation from facilities in areas of right prescriptions, early submission of claims and collection of cheques, continuous monitoring of facilities to ensure good, quality health services for subscribers are also a problem (I: SO3).You know this clinic is not for GHS, so they do not control us, we did not obtain our license from GHS but PHMHB. What matters most is that we have a license to provide health care and we are always ready to provide quality services to our clients. We got our accreditation license from the health insurance authority, but they do not control us on what services to provide and whatnot (I: PRC2).
Timeliness	There is the need to reduce the time subscribers spend at our offices through our decentralised registration system, we also make efforts to pay facilities claims on time towards quality service delivery (I: SO3).We treat patients equally whether health insurance subscribers or those who pay cash, we provide prompt services in terms of medical consultation or drug prescription, and where we cannot meet the healthcare needs of patients, we refer them to higher facilities (I: PUC2)The health care needs of subscribers are important to us and we always try our possible best not to delay their time at the facility. Above all, we provide them with good quality services (I: PRC2)
Efficiency	…we do not vacate facility early as most clinics do. Moreover, the provision of quality service to subscribers is our topmost priority here (I: PRC1-5#2)
Reimbursement	There are too many delays in payments of claims, where you provide services to insurance members for eight months without reimbursement, how.... (I: PRC1-3#3)Health insurance is good, but reimbursement is the problem. Too many delays, no payments for the whole year (from January to July). (I: PUC1-3#1)
Compliance with standard guidelines of GHS	Health facilities work within GHS treatment guidelines be it public or private facilities to ensure that the quality of health services is not compromised (I: MHO1).Health insurance officials are involved in periodic monitoring of facilities service delivery across the country (I: NIO1).
Accreditation process	We receive credentials of facilities forward them to the authority for approval. NHIA accreditation body or delegated persons can make unannounced visits to inspect facilities to ensure standards are not compromised (I: SO3).We have a strict procedure that facilities must meet for accreditation and there is no favouritism, politics, or cronyism. Some service providers when they are denied accreditation, turn to blame us on these issues instead of doing the right thing. All that is expected is for the facility to meet the basic requirements of providing at least five core areas and meet the 50% pass mark (I: RIO1).This is a big hospital and has been able to meet all the conditions required for accreditation. Meeting conditions spelt out by NHIA is not a problem in this facility but maintaining standards and upgrading to secondary care hospital is our priority (I: PUH1, 3#1).We met those conditions set for facilities and have since been accredited and have renewed many times. The goal of the hospital is to become the best hospital in the metropolis (I: PRH1, 3#3).

Source: Fieldwork data

Notes: I: MHO - Interviewed Metropolitan Health Management Team Officer; SO - Scheme Officer; PRC - Private Clinic Officer; PUC - Public Clinic Officer; NIO - National Insurance Officer; RIO - Regional Insurance Officer; PUH - Public Hospital Officer: PRH - Private Hospital Office

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