Abstract
BackgroundGhana is currently undergoing a profound demographic transition, with large increases in the number of older adults in the population. Older adults require greater levels of healthcare as illness and disability increase with age. Ghana therefore provides an important and timely case study of policy implementation aimed at improving equal access to healthcare in the context of population ageing.This paper examines the determinants of National Health Insurance (NHIS) enrolment in Ghana, using two different surveys and distinguishing between younger and older adults. Two surveys are used in order to investigate consistency in insurance enrolment. The comparison between age groups is aimed at understanding whether determinants differ for older adults. Previous studies have mainly focused on the enrolment of young and middle aged adults; thus by widening the focus to include older adults and taking into account differences in their demographic and socio-economic characteristics this paper provides a unique contribution to the literature.MethodsUsing data from the 2007-2008 Study on Global Ageing and Adult Health (SAGE) and the 2012-2013 Ghanaian Living Standards Survey (GLSS) the determinants of NHIS enrolment among younger adults (aged 18-49) and older adults (aged 50 and over) are compared. Logistic regression explores the socio-economic and demographic determinants of NHIS enrolment and multinomial logistic regression investigates the correlates of insurance drop out.ResultsSimilar results for people aged 18-49 and people aged 50 plus were revealed, with older adults having a slightly lower probability of dropping out of insurance coverage compared to younger adults. Both surveys confirm that education and wealth increase the likelihood of NHIS affiliation. Further, residential differences in insurance coverage are found, with greater NHIS coverage in urban areas. The findings give assurance that both datasets (SAGE and GLSS) are suitable for research on insurance affiliation in Ghana.ConclusionThe paper indicates that although the gap in coverage among rich and poor and urban and rural residents appears to have decreased, these factors still determine NHIS coverage of younger and older adults. The same holds for education. Increasing efforts are needed to ensure equal access to healthcare.
Highlights
Ghana is currently undergoing a profound demographic transition, with large increases in the number of older adults in the population
Comparing National Health Insurance (NHIS) coverage of 18-49 year olds by gender, the Ghanaian Living Standards Survey (GLSS) indicates a higher enrolment rate among females compared to males
The GLSS highlights that females are significantly more likely to enrol in the NHIS (OR: 1.99 CI: 1.86-2.13)
Summary
Ghana is currently undergoing a profound demographic transition, with large increases in the number of older adults in the population. Ghana provides an important and timely case study of policy implementation aimed at improving equal access to healthcare in the context of population ageing. This paper examines the determinants of National Health Insurance (NHIS) enrolment in Ghana, using two different surveys and distinguishing between younger and older adults. Older adults require greater levels of healthcare due to increasing illness and disability as ageing occurs, which complicates progress to UHC. Ghana presents a crucial case study for the implementation of policies aimed at UHC in the context of population ageing in sub-Saharan Africa. Ghana is currently undergoing a profound demographic transition, with a large increase in the number of older adults. In 2005 the country implemented a National Health Insurance Scheme (NHIS), designed to help improve equality of access to healthcare by offering affordable healthcare to all
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
