Abstract
Background. In the quest to prevent households from making catastrophic expenditures at the point of seeking healthcare, the government of Ghana introduced the National Health Insurance in 2003. However, people are reluctant to renew their membership. This study was, therefore, conducted to identify factors influencing the nonrenewal of National Health Insurance membership in the Ejisu-Juaben Municipality. Methods. A cross-sectional study was conducted among 427 respondents in the Ejisu-Juaben Municipality to ascertain factors influencing the nonrenewal of health insurance membership status. Data were entered and analyzed using Stata version 14. Univariate and multivariate analyses were performed to determine sociodemographic factors, household factors, and systemic factors influencing the nonrenewal of health insurance status. Statistical significance for all testing was set as p ≤ 0.05 . Results. Sociodemographic factors such as gender (AOR = 0.531; CI = 0.287–0.985) and educational level (AOR = 5.268; CI = 1.130–24.551)) were associated with the nonrenewal of health insurance membership. Income levels in Ghana Cedis were 500–1000 (AOR = 0.216; CI = 0.075–0.617) and 1001–2000 (AOR = 0.085; CI = 0.019–0.383). Systemic decision on factors such as clients’ satisfaction (AOR = 0.149; CI = 0.035–0.640), making copayment (AOR = 0.152; CI = 0,068–0.344), acquiring all prescribed drugs (AOR = 4.191; CI = 2.027–8.668), and awareness of mobile renewal (AOR = 3.139; CI = 1.462–6.739) was associated with nonrenewal of membership. Conclusions. The nonrenewal of health insurance membership was influenced by sociodemographic, household, and systemic factors. Therefore, the Municipal Health Directorate and the National Health Insurance Authority have to work on these factors to reach the target of 100% active coverage in the municipality.
Highlights
In the quest to prevent households from making catastrophic expenditures at the point of seeking healthcare, the government of Ghana introduced the National Health Insurance in 2003
Univariate and multivariate analyses were performed to determine sociodemographic factors, household factors, and systemic factors influencing the nonrenewal of health insurance status
Conclusions. e nonrenewal of health insurance membership was influenced by sociodemographic, household, and systemic factors. erefore, the Municipal Health Directorate and the National Health Insurance Authority have to work on these factors to reach the target of 100% active coverage in the municipality
Summary
Health insurance coverage is an imperative aspect of achieving Universal Health Coverage (UHC) [1, 2]. A study by Escobar et al (2010) in Costa Rica, Peru, Indonesia, Rural China, Columbia as well as Ghana on the impact of health insurance in low- and middle-income countries ascertained a positive. In 2012, the Ghana Parliament made the membership of National Health Insurance Scheme (NHIS) mandatory for all residents in the country through an Act of Parliament [6]. Some studies have been conducted in the Eastern, Central, and Volta Regions of Ghana to ascertain factors that influence enrolment and retention into the health insurance scheme [9, 10]. Ashanti Region, the second largest and the most populated region in Ghana, had not benefited from such studies For those regions, which have benefited from such studies, the investigations were facilitybased, scheme-based, and based on individual factors influencing the nonrenewability of NHIS. Household factors, and health system factors influenced the nonrenewability of NHIS membership had not been adequately explored in Ghana. erefore, there was a need for such a study to be conducted in the EjisuJuaben Municipality as a lesson from the region could be used in other regions in the country and even in other countries in the subregion. is will help put measures in place to propel the country toward achieving its aim of 100% health insurance coverage
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