Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review

Abstract

BackgroundApproximately 150 million people suffer from financial catastrophe annually because of out-of-pocket expenditures (OOPEs) on health. Although the National Health Insurance Scheme (NHIS) of Ghana was designed to promote universal health coverage, OOPEs as a proportion of total health expenditures remains elevated at 26%, exceeding the WHO’s recommendations of less than 15–20%. To determine whether enrollment in the NHIS reduces the likelihood of OOPEs and catastrophic health expenditures (CHEs) in Ghana, we undertook a systematic review of the published literature.MethodsWe searched for quantitative articles published in English between January 1, 2003 and August 22, 2017 in PubMed, Google Scholar, Economic Literature, Global Health, PAIS International, and African Index Medicus. Two independent authors (J.S.O. & S.E.) reviewed the articles for inclusion, extracted the data, and conducted a quality assessment of the studies. We accepted the World Health Organization definition of catastrophic health expenditures which is out of pocket payments for health care which exceeds 20% of annual house hold income, 10% of household expenditures, or 40% of subsistence expenditures (total household expenditures net food expenditures).ResultsOf the 1094 articles initially identified, 7 were eligible for inclusion. These were cross-sectional household studies published between 2008 and 2016 in Ghana. They demonstrated that the uninsured paid 1.4 to 10 times more in out-of-pocket payments (OOPs) and were more likely to incur CHEs than the insured. Yet, 6 to 18% of insured households made catastrophic payments for healthcare and all studies reported insured members making OOPs for medicines.ConclusionEvidence suggests that the national health insurance scheme of Ghana over the last 14 years has made some impact on reducing OOPEs, and yet healthcare costs remain catastrophic for a large proportion of insured households in Ghana. Future studies need to explore reasons for the persistence of OOPs for medicines and services that are covered under the scheme.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3249-9) contains supplementary material, which is available to authorized users.

Health seeking behaviour and cost of fever treatment to households in a malaria endemic setting of northern Ghana: A cross sectional study

“…Overall, the average cost incurred in the treatment of malaria by the uninsured was greater (GH¢43.95/US$11.57) than their insured counterparts (GH¢24.75/US$6.51). Thus, the uninsured paid US$5 more than the insured, which is consistent with many findings where the uninsured paid more than the insured in treating malaria [12,15,36]. Though the insured were not supposed to incur direct medical costs, a possible reason for the cost incurred by the insured could be due to co-payments for drugs, laboratory test, ward dues and other informal payments.…”

“I couldn’t buy the items so I didn’t go to deliver at the health facility” Home delivery among rural women in northern Ghana: A mixed-method analysis

“…There were no private maternity homes in the district. Women in the reproductive age (15-49 years) form 24% (9,192) of the total population of the district [22].…”

“…The user-fees exemption policy (or NHIS) that has been in place for the past decade or so has contributed significantly to reducing out-of-pocket expenditure for maternal health services received from the public health facilities in Ghana [8,9]. An evaluation of the policy in the Central and Volta regions in Ghana revealed an increase in the percentage of health-facility deliveries post-implementation [10].…”

“…However, reports have emerged more recently that some beneficiary households of the userfees exemption policy in Ghana still suffer some level of catastrophic costs in receiving primary health care in public health institutions [9].…”

Effect of Critical Illness Insurance on Household Catastrophic Health Expenditure: The Latest Evidence from the National Health Service Survey in China

“…They adopted the thresholds of CHE that OOP for healthcare exceeds 20% of annual household income, 10% of household expenditures, and 40% of subsistence expenditures, respectively. Findings suggested that healthcare costs remain catastrophic for a large proportion of insured households in Ghana [15]. Two other studies by Xie et al [16] and Guo et al [17] evaluated the role of the Chinese new rural cooperative medical scheme (NRCMS) on protecting households from CHE using 40% of a household's capacity to pay as the threshold.…”