Gendered inequalities within Ghana's National Health Insurance Scheme: are poor women being penalized with a late renewal policy?

Abstract

This article addresses the implications of the mandatory delay in coverage for individuals residing in the Upper West Region (UWR) of Ghana who have dropped out of the National Health Insurance Scheme (NHIS) but later attempt to reenroll. Using data collected in 2011 in Ghana's UWR, we use a negative log-log model (n=1,584) to compare those who remain enrolled in the scheme with those who have dropped out. Women with unreliable incomes, who reported being food-insecure and those living with young children were more likely to drop out (OR range: 1.22-1.79, p<.05). Men, in contrast, were 50% more likely to drop out of the NHIS for being unsatisfied with services provided (OR range: 1.25-1.62, p<.01). Contrary to the original mandate of the NHIS, our study reveals clear gender differences in the factors contributing to dropouts, pointing to a bias in the impact of the block-out policy that is penalizing women for being poor.