Citizenship and Health Reform: An Analytical Review of the Politics and Institutional Arrangement of Ghana’s National Health Insurance Scheme

摘要

Recent studies on health financing reform in Ghana have focused on the institutional legacies and political forces underpinning the dramatic shift from “cash-and-carry” to policy initiatives that find expression in universalism and social inclusion. Yet little attention has been paid to the complex interactions between institutional and ideational elements that account for the policy failure of Ghana’s National Health Insurance Scheme (NHIS). Drawing primarily on government records, published books, articles and newspaper publications, we argue that formulating appropriate financial reform strategies requires a proper understanding of how national identities intersect with, and shape the politics, design, and operation of social programs to inform policy outcomes. The article suggests that the sustainability of Ghana’s NHIS rests on strategic reform measures including, cost containment, diversified funding and operational arrangement, as well as depoliticization of the health regime.