Abstract
BackgroundGhana’s National Health Insurance Scheme (NHIS), established into law in 2003 and implemented in 2005 as a ‘pro-poor’ method of health financing, has made great progress in enrolling members of the general population. While many studies have focused on predictors of enrolment this study offers a novel analysis of NHIS members’ perceptions of service provision at the national level.MethodsUsing data from the 2008 Ghana Demographic Health Survey we analyzed the perceptions of service provision as indicated by members enrolled in the NHIS at the time of the survey (n = 3468; m = 1422; f = 2046). Ordinal Logistic Regression was applied to examine the relationship between perceptions of service provision and theoretically relevant socioeconomic and demographic variables.ResultsResults demonstrate that wealth, gender and ethnicity all play a role in influencing members’ perceptions of NHIS service provision, distinctive from its influence on enrolment. Notably, although wealth predicted enrolment in other studies, our study found that compared to the poorest men and uneducated women, wealthy men and educated women were less likely to perceive their service provision as better/same (more likely to report it was worse). Wealth was not an important factor for women, suggesting that household gender dynamics supersede household wealth status in influencing perceptions. As well, when compared to Akan women, women from all other ethnic groups were about half as likely to perceive the service provision to be better/same.ConclusionsFindings of this study suggest there is an important difference between originally enrolling in the NHIS because one believes it is potentially beneficial, and using the NHIS and perceiving it to be of benefit. We conclude that understanding the nature of this relationship is essential for Ghana’s NHIS to ensure its longevity and meet its pro-poor mandate. As national health insurance systems are a relatively new phenomenon in sub-Saharan Africa little is known about their long term viability; understanding user perceptions of service provision is an important piece of that puzzle.
Highlights
Ghana’s National Health Insurance Scheme (NHIS), established into law in 2003 and implemented in 2005 as a ‘pro-poor’ method of health financing, has made great progress in enrolling members of the general population
An odds ratio less than one indicates a lower likelihood of Results Univariate results in Table 2 are provided for the dependent variable and selected explanatory variables for the sample of male (n = 1422) and female (n = 2046) respondents who were card-carrying members of the Perception of NHIS service provision
In contrast to male respondents, wealth was not significantly associated with women’s perceptions of NHIS service provision, and we suggest that this result throws light on the gender dynamics of intra-household resource allocation
Summary
Ghana’s National Health Insurance Scheme (NHIS), established into law in 2003 and implemented in 2005 as a ‘pro-poor’ method of health financing, has made great progress in enrolling members of the general population. Financing health care costs through health insurance schemes are a crucial tool for developing countries to avoid financial barriers to health care and protect individuals from catastrophic health care spending. Those covered by insurance are more likely to have access to care and less likely to be burdened by health in 2003 and began operation in 2005, though exact dates vary by district. Cash-and-carry, was wildly unpopular and socially regressive This is largely because the poor and other marginalized populations had very little ability to access mainstream health care, and the model created disincentives to provide care in remote rural areas of the country. During the 2000 general election in Ghana, the New Patriotic Party (NPP) campaigned, and subsequently won, on a platform that promised to get rid of cash-and-carry and introduce a pro-poor health insurance model for the country [4]
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