Evaluating services for perinatal asphyxia and low birth weight at two hospitals in Ghana: a micro-costing analysis

Background: Neonatal mortality has been decreasing slowly in Ghana despite investments in maternal-newborn services. Although community-based interventions are effective in reducing newborn deaths, hospital-based services provide better health outcomes.Objective: To examine the process and cost of hospital-based services for perinatal asphyxia and low birth weight/preterm at a district and a regional level referral hospital in Ghana.Methods: A cross-sectional study was conducted at 2 hospitals in Greater Accra Region during May-July 2016. Term infants with perinatal asphyxia and low birth weight/preterm infants referred for special care within 24hours after birth were eligible. Time-driven activity-based costing (TDABC) approach was used to examine the process and cost of all activities in the full cycle of care from admission until discharge or death. Costs were analysed from health provider’s perspective.Results: Sixty-two newborns (perinatal asphyxia 27, low-birth-weight/preterm 35) were enrolled. Cost of care was proportionately related to length-of-stay. Personnel costs constituted over 95% of direct costs, and all resources including personnel, equipment and supplies were overstretched.Conclusion: TDABC analysis revealed gaps in the organization, process and financing of neonatal services that undermined the quality of care for hospitalized newborns. The study provides baseline cost data for future cost-effectiveness studies on neonatal services in Ghana.Keywords: perinatal asphyxia; low-birth-weight; time-driven activity-based costing; process of careFunding: Authors received no external funding for the stud

Built-in premium effects within exotic FX options

Purpose: This paper explains the analysis of built-in premium within ‘premium-free’ FX Option strategies, also known as ‘exotic options’. The aim is to analyse whether such an increase in built-in premium would have an effect on the outcome of the strategies. Methodology: The analysis was conducted through three different currency pairs, namely, the EURUSD, EURJPY and EURGBP, throughout a period between 2007 to 2014. The authors used the Bloomberg terminal to design two different option strategies: Window Forward Extra and At Expiry Forward Extra. These strategies are known as low risk hedging strategies within the FX options industry. The authors examined different combinations of changes in built-in premium and analysed the respective outcome with each combination. The outcomes were compared to analyse whether an increase in built-in premium would have an effect on the outcome of the strategy. A test was also conducted should these strategies be used as a speculative tool. The strategies were built on a 1 year tenor which is rolled over every month. Hence, each month a hedge using the strategy for 1 year was conducted. The authors used back dated implied volatilies when performing the back-testing in order for results to be realistic. Findings: In most cases it was found that there was no effect on the outcome of the strategy. However, this was only valid if an expiry at a time is taken. On the other hand, when taking into account the whole sample, even though only 3% of the times there was an effect on the outcome of the strategy, the total result finds that an increase in built-in premium has an effect on the outcome of the strategy. Such result was found to be statistically significant using a paired sample t-test. This applied for all currency pairs under review. When analysing the exotic option strategies for speculative purposes, the authors found that in most cases it would have been better for brokers to take higher risk and receive an upfront Premium.peer-reviewe

Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana : a cross-sectional study

Earlier studies have found significant associations between sociodemographic factors and enrolment in the National Health Insurance Scheme (NHIS) in Ghana. These studies were mainly household surveys in relatively rural areas with high incidence of poverty. To expand the scope of existing evidence, this paper examines policy design factors associated with enrolment and dropout of the scheme in an urban poor district using routine secondary data.; This study is a cross-sectional quantitative analysis of 2014-2016 NHIS enrolment data of the Ashiedu Keteke district office. Descriptive and multivariate logistic regression analyses were performed to examine sociodemographic factors associated with NHIS enrolment and dropout.; A total of 215,724 individuals enrolled in the NHIS over the period under study, of which 98,232 (46%) were new members. About 41% of existing members in 2014 dropped out of the NHIS in 2015 and 53% of those in 2015 dropped out in 2016. The indigents (core poor) are significantly more likely to enrol and to drop out of the NHIS. However, the males, informal sector employees, social security and national insurance trust (SSNIT) contributors, and the aged (70+ years) are significantly less likely to enrol in the NHIS but more likely to retain coverage.; A considerable number of members are dropping out of the NHIS. The indigents in particular, are increasingly enrolling in and dropping out of the NHIS whilst the males, informal sector employees, SSNIT contributors and the aged are not enrolling as expected but increasingly retaining coverage. Policy reforms to ensuring continued growth towards realization of universal health coverage should take these factors into consideration

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Subin sub-metro interview results – responses/statements from respondents in Subin sub-metro of the Ashanti region. (DOCX 29 kb

Trends and characteristics of enrolment in the National Health Insurance Scheme in Ghana: a quantitative analysis of longitudinal data

Abstract Background In 2004, Ghana started experimenting a National Health Insurance Scheme (NHIS) to reduce  out-of-pocket payment for healthcare. Like many other social health insurance schemes in Africa, the NHIS is striving for universal health coverage (UHC). This paper examines trends and characteristics of enrolment in the scheme to inform policy decisions on attainment of UHC. Methods We conducted trend analysis of longitudinal enrolment data of the NHIS for the period, 2010–2017. Descriptive statistics were used to examine trends and characteristics of enrolment by geographical region and member groups. Results Over the 8-year period, the population enrolled in the scheme increased from 33% (8.2 million) to 41% (11.3 million) between 2010 and 2015 and dropped to 35% (10.3 million) in 2017. Members who renewed their membership increased from 44% to 75.4% between 2010 and 2013 and then dropped to 73% in 2017. On average, the urban regions had significantly higher number of new enrolments than the rural ones. Similarly, the urban and peri-urban regions recorded significantly higher number of renewals than the other regions. In addition, persons below the age of 18 years and the informal sector workers had significantly higher number of enrolment than any other member group. Conclusions Enrolment in the NHIS is declining and there are significant differences among geographical regions and member groups. Managers of the NHIS need to enforce the mandatory enrolment provision in the Act governing the scheme, employ innovative strategies such as mobile phone application for registration and renewals and address delays in healthcare provider claims to improve enrolment

Eight years of National Health Insurance in Ghana: Evaluation of the Health financign Sub-Functions

In 2003, Ghana introduced National Health Insurance Scheme (NHIS) to provide financial access to healthcare for all residents. It was implemented in 2004 in 145 districts nationwide. This study aimed to evaluate the NHIS in terms of health financing sub-functions of revenue collection, risks pooling, and purchasing of health care using the Ashiedu Keteke District NHIS Office as a case study. The review and participant observation methods were employed to analyze secondary data of the NHIS. Reviews were conducted on NHIS operational documents, annual reports, and published literature. A data compilation sheet was used to collect membership, revenue and expenditure data from the AshieduKeteke District NHIS Office. Out of 158,466 members who registered over the period under study (2005-2012), about 30% were active card-bearing members. The population coverage increased consistently from 6.4% to 29.9% over the study period. Children below eighteen years of age were the most registered members (42.2%). Membership is legally mandatory and household-based. The NHIS is largely tax-funded: prepaid contributions declined from 20% to 15.4% over the study period. There was multiple fund system between 2005 and 2009; however, in 2011, a single risk pool (single fund system) was implemented to maximize risk pooling and administrative efficiency. There is comprehensive one-for-all benefit package for ensuring equity and adequate financial protection. The provider payment mechanism changed from fee-for-service in 2005 to Diagnostic Related Groupings (DRG) in 2008; although, fee-for-service is still used to pay for medications. In 2011, capitation payment was implemented for out-patient services at primary health centers. The administrative expenditure is relatively high; however, it declined from 42.1% to 13.3% over the period, 2006- 2012. The population coverage of the Ashiedu Keteke District NHIS Office is increasing with a decreasing trend in administrative expenditure. Given that more than fifty percent of the membership groups are exempted from paying contributions and the extent of prepayment is declining, large scope of government subsidies would be needed to ensure long-term financial sustainability

Perception of quality health care delivery under capitation payment: a cross-sectional survey of health insurance subscribers and providers in Ghana

Contains fulltext : 190049.pdf (publisher's version ) (Open Access

Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana

Contains fulltext : 208048.pdf (publisher's version ) (Open Access

Correction: Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana.

[This corrects the article DOI: 10.1371/journal.pone.0221195.]