The introduction of the Ghana National Health Insurance Scheme has led to a tremendous increase
in utilisation of health services. However, concerns are raised about the quality of care, especially
in relation to insured patients. Previous studies related to patients’ perceptions of quality of care
in Ghana are limited in scope in terms of dimensions of quality assessment, and the effect of socioeconomic
and demographic characteristics of respondents. Also, no study has compared
perceptions of quality of care between patients and healthcare providers. This thesis therefore
aimed to provide a more comprehensive assessment of quality of care by examining a broader
range of dimensions for the assessment of quality of care, within the context of major socioeconomic
and demographic characteristics of respondents and organizational factors. The study
also compared perceptions of quality of care between patients and healthcare providers to examine
whether the two stakeholders have similar or divergent perceptions of quality of care.
A cross-sectional survey of out-patients was conducted in 17 general hospitals from three regions
in Ghana. Both insured and uninsured patients, as well as healthcare providers were selected for
interview. Multi-stage sampling strategy was employed, culminating in the selection of patients
and healthcare providers through convenience and purposive sampling respectively. IBM SPSS
version 20 software was used to perform all statistical analysis, including factor analysis, chisquare
test, t-tests, and multiple regression analysis. Qualitative data was analysed according to
themes. The study found that generally, there is no significant difference in perceptions of quality
between the insured and uninsured patients, except financial access to care. On the contrary,
quality of care was a general concern expressed by both insured and uninsured patients. Long
waiting times and inadequacy of resources and services, specifically inadequacy of doctors, drugs
and equipment for work, were the major quality of care problems expressed by both categories of
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patients. Regression analysis showed that being insured had a statistically significant positive
effect on only financial access to care. However, some control variables such as age, marital status,
income levels, health status and hospital size, rather had more influence on the various dimensions
of quality of care. The study also found that generally, there were wide gaps in perceptions of
quality of care between patients and healthcare providers, with the former tending to rate quality
relatively lower than the latter. The reasons for these differences however, were beyond the scope
of this study. The study concluded that there is no difference in perceptions of quality of care
between insured and uninsured patients; and that prevailing anecdotal and empirical views that
insured patients are discriminated against in terms of quality of care is largely not supported. On
the contrary, concerns related to quality of care are raised by both the insured and uninsured. It
was recommended, among others, that efforts must be taken to sustain the NHIS, eliminate or
drastically reduce out-of-pocket payments by some insured patients and address quality concerns
affecting both categories of patients or healthcare providers.