An Evaluation of Perceived Quality of Care Between Insured and Uninsured Patients in Ghana's Hospitals

Purpose: The introduction of social health insurance in Ghana in 2003 has resulted in tremendous increase in utilization of health services. However, concerns are being raised by various stakeholders about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, poor physical examination by doctors and discrimination against insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in Ghana’s hospitals to establish whether both categories of patients are treated equally (fairly) or indeed, insured patients are discriminated against in terms of quality of care in hospitals .

Methods: A cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics including frequency distributions, means and standard deviations were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the effect of health insurance status on quality of care.

Results: Overall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with.

Conclusion: It was concluded that insured patients are generally not discriminated against, contrary to prevailing anecdotal and empirical evidence. On the contrary quality of care is a concern of both insured and uninsured patients. Therefore health care providers and policy makers must adopt measures aimed at improving quality of care for all categories of patients.