Abstract A87: The epidemiology of breast and cervical cancer: Pre-and post-National Health Insurance Scheme in Ashanti region of Ghana

Abstract

Abstract Background: The relationship between breast and cervical cancer, inequality in income distribution and access to health care has attracted much attention during the last two decades. To reduce this problem of financial access to health care, Ghana's government is committed, and has introduced a convenient, affordable and sustainable health financing arrangement to protect the people, especially the poor, through the National Health Insurance Scheme (NHIS). Breast cancer and cervical cancer, once rare, is now becoming a major public health concern in Kumasi, Ghana. The introduction of the “cash and carry” system in 1992 compounded the problem of financial access to quality health care, and thus led to low utilization of health services especially, by the poor. This led to deteriorating health status for the people of Ghana. Though laudable, little is known about the efficacy of the health insurance in improving breast and cervical cancer care in Ghana. The purpose of this study was to examine the epidemiology of breast and cervical cancer both prior to and following the enactment of the NHIS. Time-Series data obtained from the Ghana Okonfo Anokye Teaching Hospital was utilized. Methods: This project consisted of two phases. Medical records of inpatient and outpatient records for the period of 2001 through 2009 in the hospital were reviewed. Phase 1 consisted of pre-NHIS and post-NHIS data compilation and aggregation, variable construction and univariate and bivariate descriptive statistics provided an overview of the state of the health care system in Ghana. Phase 2 consisted of a time series analysis on 2001-2009 data. The SAS Proc ARIMA was utilized to determine if significant changes in the demographic characteristics of inpatients and outpatients occurred after the institution of the NHIS. Results: Ghana recorded 0.54 outpatient visits per capita in 2005 (before national health insurance). The hospital admission rate was 36.5, per 1000 in 2005. Skilled obstetrical deliveries increased to 40.3% in 2005. It is against this background that trends in inpatient and outpatient medical visits were analyzed. Trends by gender, age, and diagnostic group were examined over an eight year period. Conclusions: Prior to 2006 the country instituted a national health insurance plan. This plan provided free health coverage to all citizens. Prior to the NHIS the predominant mode of payment for healthcare services was cash and carry. Rates of outpatient services provided and inpatient admissions have changed by age group, gender and by diagnosis after national health insurance in Ghana. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A87.