National health insurance coverage and socio‐economic status in a rural district of Ghana

Abstract

Summaryobjective To explore the association between socio-economic status (SES) and health insurance subscription to the Ghanaian National Health Insurance Scheme (NHIS) of residents of the Asante Akim North district of the Ashanti Region, Ghana.methods In the course of a community survey, data on asset variables (e.g. electricity, housing conditions and other variables) and on NHIS subscription were collected on the household level in 99 villages. Using principal components analysis, households were classified into three categories of SES (20% high, 40% middle and 40% low SES). Odds ratios of NHIS subscription were calculated for all SES categories, using the low category as the reference group and adjusting for travelling time to health facilities by public transport.results Of the 7223 households surveyed, 38% subscribed to the NHIS, of these 21% were low, 43% middle and 60% high SES households. SES was significantly associated with NHIS subscription (high SES: OR 4.9, 95% CI 4.3-5.7; middle SES: OR 2.5, 95% CI 2.2-2.9; low SES: OR 1, reference group).

The Politics of Universal Health Coverage in Low and Middle-Income Countries: A Framework for Evaluation and Action

“…Similarly, a graduated, means-tested premium has been abandoned in favor of a low, fixed annual premium for all (the equivalent of about US$7 per year) due to difficulties in collection (Witter and Garshong 2009). While affiliation in Ghana has been growing rapidly, only an estimated 59 percent of the population has registered with the national health insurance service, and evidence shows that enrollment unequally favors the relatively wealthy (Asante and Aikins 2008;Sarpong et al 2010). Budget shortfalls resulted in a failure to pay outstanding facility claims in 2008, which severely undermined the legitimacy of the program in the eyes of providers (Witter and Garshong 2009).…”

Determinants of enrolment in the NHIS for women in Ghana – a cross sectional study

“…It has been found that certain groups of persons, especially the poor are systematically excluded from the NHIS [11][12][13][14]. Women have been noted to face greater difficulties in accessing adequate care.…”

“…Health insurance replaces outof-pocket expenditures at the point of need with smaller regular contribution (premiums), which allows individuals to gain access to care, especially some of those who previously could not afford it [20][21]. While health insurance improves access to health care for members, there will still be individuals who cannot afford the premiums [13,22]. Access to health care can also be restricted by other indirect financial and non-financial barriers, such as travel costs, loss of income, and other social and cultural values [23][24][25].…”

Oh, as for the Health Insurance…it’s good, but…: rural elders in Agate, Ghana, discuss the National Healthcare Insurance Scheme

“…3 (p. 3) After declaring independence from British rule in 1957, healthcare was available without point of service fee. 4 (p. 128) This changed to a cash and carry system in the 1980s, 5 creating access obstacles. 4 President Kufuor (elected 2001 and 2005), 6 attempted to provide national healthcare for all and The National Health Insurance Law passed in 2003.…”