The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation

Springer Science and Business Media LLC - Tập 19 - Trang 1-14 - 2019
Anthony Kwarteng1, James Akazili2, Paul Welaga2, Philip Ayizem Dalinjong2, Kwaku Poku Asante1, Doris Sarpong3, Samuelina Arthur4, Martin Bangha4, Jane Goudge5, Osman Sankoh6
1Kintampo Health Research Center, Ghana Health Service, Kintampo, Ghana
2Navrongo Health Research Center, Ghana Health Service, Navrongo, Ghana
3Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana
4INDEPTH-Network, Accra, Ghana
5Center for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
6INDEPTH Network, Accra, Ghana

Tóm tắt

In 2004, Ghana implemented a national health insurance scheme (NHIS) as a step towards achieving universal health coverage. In this paper, we assessed the level of enrollment and factors associated with NHIS membership in two predominantly rural districts of northern Ghana after eight years of implementation, with focus on the poor and vulnerable populations. A cross-sectional survey was conducted from July 2012 to December 2012 among 11,175 randomly sampled households with their heads as respondents. Information on NHIS status, category of membership and socio-demographic characteristics of household members was obtained using a structured questionnaire. Principal component analysis was used to compute wealth index from household assets as estimates of socio-economic status (SES). The factors associated with NHIS enrollment were assessed using logistic regression models. The reasons behind enrollment decisions of each household member were further investigated against their SES. Approximately half of the sampled population of 39,262 were registered with a valid NHIS card; 53.2% of these were through voluntary subscriptions by payment of premium whilst the remaining (46.8%) comprising of children below the ages of 18 years, elderly 70 years and above, pregnant women and formal sector workers were exempt from premium payment. Despite an exemption policy to ameliorate the poor and vulnerable households against catastrophic health care expenditures, only 0.5% of NHIS membership representing 1.2% of total exemptions granted on accounts of poverty and other social vulnerabilities was applied for the poor. Yet, cost of premium was the main barrier to NHIS registration (92.6%) and non-renewal (78.8%), with members of the lowest SES being worst affected. Children below the ages of 18 years, females, urban residents and those with higher education and SES were significantly more likely to be enrolled with the scheme. Despite the introduction of policy exemptions as an equity measure, the poorest of the poor were rarely identified for exemption. The government must urgently resource the Department of Social Welfare to identify the poor for NHIS enrollment.

Tài liệu tham khảo

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