Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme.

Genevieve Cecilia Aryeetey,Judith Westeneng,Ernst Spaan,Rob Baltussen,Irene Akua Agyepong,Caroline Jehu-Appiah

doi:10.1186/s12939-016-0401-1

Abstract

BackgroundGhana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty.MethodsWe conducted two repeated household surveys in two regions of Ghana in 2009 and 2011. We first analyzed the effect of OOPE on poverty by estimating poverty headcount before and after OOPE were incurred. We also employed probit models and use of instrumental variables to analyze the effect of health insurance on OOPE, CE and poverty.ResultsOur findings showed that between 7–18 % of insured households incurred CE as a result of OOPE whereas this was between 29–36 % for uninsured households. In addition, between 3–5 % of both insured and uninsured households fell into poverty due to OOPE. Our regression analyses revealed that health insurance enrolment reduced OOPE by 86 % and protected households against CE and poverty by 3.0 % and 7.5 % respectively.ConclusionThis study provides evidence that high OOPE leads to CE and poverty in Ghana but enrolment into the NHIS reduces OOPE, provides financial protection against CE and reduces poverty. These findings support the pro-poor policy objective of Ghana’s National Health Insurance Scheme and holds relevance to other low and middle income countries implementing or aiming to implement insurance schemes.

Highlights

Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service
Poverty levels declined from 34 % to 20 % while household enrolment into the NHIS increased from 31 % to 37 %
The effect of poverty on of-pocket expenditure (OOPE) revealed that some 3–5 % of both insured and uninsured households fell into poverty between 2009 and 2011

Summary

Introduction

Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty. Households without adequate financial protection face the risk of incurring large unforeseen medical expenditures should they fall ill. Ghana’s National Health Insurance Scheme In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) as part of the government’s policy to minimize the financial burden of OOPE at point of service and to ensure equitable access to health care, among the poor. Apart from beneficiaries of the livelihood empowerment against poverty (LEAP) [18], a conditional cash transfer program, the identification of indigents leaves a large amount of discretion to the staff of the district scheme offices

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Conclusion