Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana

Abstract

BackgroundGhana’s National Health Insurance Scheme has improved access to care, although equity and sustainability issues remain. This study examined health insurance coverage, type of payment for health insurance and reasons for being uninsured under the National Health Insurance Scheme in Ghana.MethodsThe 2014 Ghana Demographic Health Survey datasets with information for 9396 women and 3855 men were analyzed. The study employed cross-sectional national representative data. The frequency distribution of socio-demographics and health insurance coverage differentials among men and women is first presented. Further statistical analysis applies a two-stage probit Hackman selection model to determine socio-demographic factors associated with type of payment for insurance and reasons for not insured among men and women under the National Health insurance Scheme in Ghana. The selection equation in the Hackman selection model also shows the association between insurance status and socio-demographic factors.ResultsAbout 66.0% of women and 52.6% of men were covered by health insurance. Wealth status determined insurance status, with poorest, poorer and middle-income groups being less likely to pay themselves for insurance. Women never in union and widowed women were less likely to be covered relative to married women although this group was more likely to pay NHIS premiums themselves. Wealth status (poorest, poorer and middle-income) was associated with non-affordability as a reason for being not insured. Geographic disparities were also found. Rural men and nulliparous women were also more likely to mention no need of insurance as a reason of being uninsured.ConclusionTailored policies to reduce delays in membership enrolment, improve positive perceptions and awareness of National Health Insurance Scheme in reducing catastrophic spending and addressing financial barriers for enrolment among some groups can be positive precursors to improve trust and enrolments and address broad equity concerns regarding the National Health Insurance Scheme.

Inequalities in out-of-pocket health expenditure among women of reproductive age: after-effects of national health insurance scheme initiation in Ghana

“…The findings of the study revealed that about two thirds of women are covered by health insurance. This is consistent with reports from a previous study regarding the proportion of the population actively enrolled in the national health insurance scheme [ 25 ]. Moreover, our findings on pro-rich out-of-pocket expenditure were consistent with the results from previous studies conducted in resource-poor settings that respondents from higher household wealth quintiles were more likely to have out-of-pocket health expenditures compared with their counterparts from poor household wealth quintiles [ 26 – 28 ].…”

A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

“…This is similar to previous studies that reported that women of reproductive age were more likely to obtain more information on health insurance than men [58,59]. Even though women were more likely to lack a support system and have poor participation in economic activities to purchase health insurance plans, studies have reported that women were more willing to pay to become active health insurance subscribers [58,59]. The association between gender and health insurance is similar but more complex in other research.…”

“…The direction of influence of gender on health insurance uptake is varied in the literature; one study did not find significant differences in health insurance coverage based on sex in Kenya [55][56][57]. Conversely, few studies have shown that decreased insurance uptake among males is a result of them seeming to be risk-takers [52,53], while further studies have reported that increased health insurance uptake by women was as a result of greater needs for healthcare services [58,59]. However, the decrease in women's uptake of health insurance in both countries may be associated with the low socio-economic status of women relative to men.…”

“…However, the decrease in women's uptake of health insurance in both countries may be associated with the low socio-economic status of women relative to men. Women are more economically disadvantaged, and typically have poor access to health programmes owing to the extremely patriarchal pattern occurring in rural communities [58][59][60]. Furthermore, women's education is lower, ensuing lower participation rates in social and health interventions, inferring that women may likely seek alternative healthcare services away from the orthodox health system.…”

Health insurance awareness and its uptake in India: a systematic review protocol

“…17 Inadequate claim returns, poor accountability and non-transparent operations hinders the uptake of health insurance. 18 In Indian studies, a scant that is, 34% of the participants who did not have health insurance were willing to pay for any health insuance. 5 Previous research in LMICs suggests that financial status of household is positively associated with WTP.…”