Developing Country Studies www.iiste.org ISSN 2224-607X (Paper) ISSN 2225-0565 (Online) Vol.4, No.8, 2014 53 Influence of Community Financing Health Insurance Schemes On In-Patient Care In Ghana: The Case Of Nkoranza Scheme Richard Fosu 1* Kofi Opoku-Asante 2 Kwame Adu-Gyamfi 3 1. Department of Accountancy, School of Business and Management Studies, Accra Polytechnic, P. O. Box GP 561 Accra, Ghana 2. Department of Accountancy, School of Business and Management Studies, Accra Polytechnic, P. O. Box GP 561 Accra, Ghana 3. Department of Marketing, School of Business and Management Studies, Accra Polytechnic, P. O. Box GP 561 Accra, Ghana * E-mail of the corresponding author: kofifosu@yahoo.com Abstract With the introduction of “cash and carry” system in the health sector in Ghana in 1985, it became difficult for many people to afford orthodox health care. In Nkoranza district, this problem manifested itself in low attendance of in-patient care (admissions) at St. Theresa’s Hospital (the only hospital in the district, a Catholic hospital). In addition, some of the patients who were hospitalised absconded after treatment because they could not afford to pay their medical bills. Consequently, in 1989, at Catholic Diocesan Health Committee (DHC) meeting at Sunyani, it was suggested that a community financing health insurance scheme be established in the district in order to reduce the hardship of the people in seeking in-patient treatment. The scheme was launched and became operational in 1992. The objectives of this study was to examine the impact of the scheme on in- patient healthcare services at the health facility in the district. It became evident from the study that insured in- patient attendance at St. Theresa’s Hospital from 1992 to 1998 increased with the scheme, constituting 52% of total admissions within the period. Keywords: cash and carry system, community financing health insurance, patronage, impact, in-patients 1. Introduction Generally, the level of productivity, quality of life and life expectancy of a people depend on their health situations. In Ghana, about 89.2% of the sick people receive a form of treatment, either orthodox or traditional. According to Ghana Statistical Survey Report (1997), about 33.3% of sick people in Ghana did not use medical services because they could not afford them, during the “cash and carry” system between1985 and 2005. This phenomenon was not limited to rural folk, but also the urban poor, as evidenced by high infant and maternal mortality, prevalence of infectious parasitic diseases and poor nutritional standards in the country. According to Interagency Group Child Mortality Estimation (IGME), the under-five mortality rate in Ghana has decreased from 122 in 1990 to 74 per 1000 live births in 2010, but it is still high as it is almost over double the average of 20 OECD Asian countries with 26 deaths per 1000 live births (2010 Ghana Millennium Development Goals Report, Nov. 2012; Health at a Glance, Asia/Pacific, OECD Library, 2012). This trend is usually accounted for by inadequate budgetary allocation to the health sector, great inequality between urban and rural incomes, in addition to differences in access to health care. The primary health care programmes that mainly target the rural people normally received less proportionate share of the government health budget. (Asenso-Okyere, 1995, p. 86). The story may not be different for most African countries as evidenced by health statistics. Pregnancy related mortality rate among Africa women is 1 in 16 during pregnancy or childbirth, sharply contrasting developed countries with just 1 in 4,000. (AFDB, June 2013, web) 1.1 Background In order to make public health institutions self-financing, the Government of Ghana by Legislative Instrument introduced a law establishing a full recovery of drug costs and hospital fees (aka cash and carry system) as part of its quest to promote economic recovery under the Structural Adjustment Programme (SAP) in early 1980s