Does Stock Market Development Enhance Private Investment in Ghana?

The paper investigates the extent to which stock market development enhances private investment in Ghana. Quarterly times series data for the period 1991(Q1) to 2011(Q4) are used. Stock market development is proxy by market capitalization. The paper adopts the Dynamic Ordinary Least Squares (DOLS) method of estimation. The results for deposit interest rates, GDP per capita, and public investment confirm complementarity hypothesis, accelerator principle, as well as "crowding-in" effect for Ghana in the long-run in their respective cases. Market capitalization also increases private investment in the long-run. However, inflation reduces private investment. In the short-run, one quarter lag and two quarters lag values of private investment and public investment respectively increases private investment, while one quarter lag value of market capitalization reduces current levels of private investment. The paper recommends further development of the stock market since doing so will attract more investors and ultimately enhance private investment

Association between Healthcare Provider Payment Systems and Health Outcomes in Ghana

Different payment systems generate different incentives for patients, providers, and purchasers. This study uncovers the effect of provider-payment methods on patient health outcomes, utilization of healthcare services and referral patterns in Ghana. Using data on 250 enrollees of the National Health Insurance Scheme (NHIS) from each payment plan (i.e., capitation and Diagnosis Related Groupings/fee-for-service plans), ordered logit, negative binomial and logit regression results showed that patients under capitation were 4.6% less likely to report better health and had 29% fewer visits relative to patients under DRG/FFS. In relation to referrals, capitated providers were more likely to refer patients than under DRG/FFS plans. Better health outcomes were reported by patients of private health facilities. Capitation in Ghana led to under-provision of care and cost-shifting, hence decreasing any efficiency gain from the reform. Purchasing of healthcare needs to be strategized to ensure efficient utilization of resources

COVID-19 in sub-Saharan Africa: impacts on vulnerable populations and sustaining home-grown solutions

© 2020, The Canadian Public Health Association. This commentary draws on sub-Saharan African health researchers’ accounts of their countries’ responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, these measures may not reach the majority of the poor. Yet, African countries’ responses to COVID-19 have also included a range of innovations, including diversification of local businesses to produce personal protective equipment, disinfectants, test kits, etc., which may expand domestic manufacturing capabilities and deepen self-reliance. African and high-income governments, donors, non-governmental organizations, and businesses should work to strengthen existing health system capacity and back African-led business. Social scientific understandings of public perceptions, their interactions with COVID-19 control measures, and studies on promising clinical interventions are needed. However, a decolonizing response to COVID-19 must include explicit and meaningful commitments to sharing the power—the authority and resources—to study and endorse solutions

Three essays in health economics

This dissertation consists of three independent essays addressing three separate health care policy issues. Essay 1, "Incentive Effects of Government Mandated Cost-Shifting," shows how mandated cost shifting, because it does not require resources to pass through the hands of government, can be an optimal form of income redistribution in providing health care to the poor of society when government is sufficiently costly. Under this system, the government mandates the proper treatment of illness regardless of ability to pay and enforces that mandate with investigation. The paper shows that under costly information on illness the physician cheats by providing the wrong treatment when treating a rich patient who has low severity illness and a poor patient who has high severity illness. In response the government also investigates the treatment of such patients. The paper also shows the conditions under which mandated cost shifting is less wastehl and beneficial to patients. Essay 2,"The Effects of the Relationship between Quantity and Quality of Care on Quality of Care," shows that the relationship between quality and quantity in the patient\u27s utility as well as in the cost of care play an important role in determining the ability of a payment scheme to induce efficient quality and quantity of care. The payment schemes examined are fixed fee for service, prospective payment, and cost sharing. The paper shows that neither prospective payment nor fixed fee for service can be used to induce a first-best provision of quality and quantity. Cost sharing is the only scheme that can be used to induce the efficient supply of both quantity and quality. Essay 3, "The Effect of Hospital Downsizing in British Columbia on the Quality of Care for Maternity Patients" uses maternity data from the Canadian province of British Columbia to estimate the effect of the reduction in hospital utilization rates and the transfer of care from hospitals to communities and to patients7 homes on readmission rates. The results show that the policy reduced hospital length of stay and increased readmission rates for maternity patients

Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage

Abstract The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.</p

Quality Effect of Early Discharge of Maternity Patients: Does Hospital Specialization Matter?

The quest to reduce health care cost has led many industrialized nations to reduce hospital length of stay. This paper uses instrumental variable estimation to estimate the effect of early discharge on readmission rates of maternity patients in British Columbia, Canada and investigates how the impact varied according to hospitals' degree of specialization. Principal component analysis was used to classify the hospitals according to their degree of specialization. The results show that the early discharge policy increased readmission rates, and this increase, varied according to the degree of specialization of the hospital. The increase in readmission rate is observed to be lowest in the very highly specialized hospitals and highest in the moderately specialized hospitals. The highly specialized hospitals are, however, capable of using resources most efficiently at least partly due to a reduction in the use of invasive procedures.