Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana
Abstract Background Ghana’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 i...
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doaj-d438f0d1104848ce97a5fd9bd1513be02021-01-03T12:06:43ZengBMCHealth Economics Review2191-19912019-12-019111510.1186/s13561-019-0255-5Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in GhanaMartin Amogre Ayanore0Milena Pavlova1Nuworza Kugbey2Adam Fusheini3John Tetteh4Augustine Adoliba Ayanore5James Akazili6Philip Baba Adongo7Wim Groot8Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied SciencesDepartment of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht UniversityDepartment of Family and Community Health, School of Public Health, University of Health and Allied SciencesDepartment of Preventive and Social Medicine, Dunedin School of Medicine, University of OtagoDepartment of Community Health, University of Ghana Medical School, School of Public Health, College of Health Sciences, University of GhanaCentre for Health Policy Advocacy Innovation & Research in Africa (CHPAIR-Africa)Ghana Health Service Research DivisionDepartment of Social and Behavioral Science, School of Public Health, University of GhanaDepartment of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht UniversityAbstract Background Ghana’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. Methods The 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. Results About 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. Conclusion Tailored 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.https://doi.org/10.1186/s13561-019-0255-5Health insurance coverageType of paymentInsured and uninsuredNational Health Insurance Scheme (NHIS)Ghana |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Martin Amogre Ayanore Milena Pavlova Nuworza Kugbey Adam Fusheini John Tetteh Augustine Adoliba Ayanore James Akazili Philip Baba Adongo Wim Groot |
spellingShingle |
Martin Amogre Ayanore Milena Pavlova Nuworza Kugbey Adam Fusheini John Tetteh Augustine Adoliba Ayanore James Akazili Philip Baba Adongo Wim Groot Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana Health Economics Review Health insurance coverage Type of payment Insured and uninsured National Health Insurance Scheme (NHIS) Ghana |
author_facet |
Martin Amogre Ayanore Milena Pavlova Nuworza Kugbey Adam Fusheini John Tetteh Augustine Adoliba Ayanore James Akazili Philip Baba Adongo Wim Groot |
author_sort |
Martin Amogre Ayanore |
title |
Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana |
title_short |
Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana |
title_full |
Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana |
title_fullStr |
Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana |
title_full_unstemmed |
Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana |
title_sort |
health insurance coverage, type of payment for health insurance, and reasons for not being insured under the national health insurance scheme in ghana |
publisher |
BMC |
series |
Health Economics Review |
issn |
2191-1991 |
publishDate |
2019-12-01 |
description |
Abstract Background Ghana’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. Methods The 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. Results About 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. Conclusion Tailored 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. |
topic |
Health insurance coverage Type of payment Insured and uninsured National Health Insurance Scheme (NHIS) Ghana |
url |
https://doi.org/10.1186/s13561-019-0255-5 |
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