Abstract
The importance of improved healthcare services under Ghana’s National Health Insurance Scheme (NHIS) is nationwide admitted. However, service improvement for insurance schemes comes with extra cost. To fill the funding gap, insurance schemes typically charge enhanced premiums. This requires clients’ approval and cooperation to implement. For this reason, this study was conducted to assess Ghana’s NHIS subscribers’ willingness to pay (WTP) enhanced premiums for improved services. Some socio-economic and demographic factors were used as covariates. WTP, being the dependent variable, was categorized into high WTP, moderate WTP, low WTP, and no WTP enhanced premiums. The likelihood of a client falling in a particular WTP category was examined using the Cumulative Ordinal Probit (COP) regression model. A likelihood ratio chi-square of 58.82 with p < 0.000 shows that the model was statistically significant, and fit for prediction. Results showed that age-groups 18-30, 30–45, unemployed, tertiary education, and level of income significantly influenced WTP. Predictions showed that for any average national health insurance user, the probability of being in high WTP, moderate WTP, low WTP and no WTP premium are respectively 0.51, 0.27, 0.11 and 0.12. Based on the results of this study, we recommend that Ghana’s NHIS should institute a progressive premium regime in order to cater for the different needs and financial abilities of clients, thus helping to fill the funding gap.
Highlights
Ghana has experienced considerable evolution in its healthcare financing
The responses were ranked as High willingness to pay (WTP) if a respondent answered “yes to 25% increase in existing premium, and yes to a further increase of ≥ 25%”, Moderate WTP if the respondent answered “yes to 25% increase in premium, but no to any further increases”, Low WTP if the respondent answered “no to 25% increase in premium, but yes to ≤ 25% decreases in existing premium”, No WTP if a respondent answered “no to any form of premium increases”
Results obtained showed that National Health Insurance Scheme (NHIS) users in the Upper East Region of Ghana are enthusiastic of improvement since 86.87% were WTP more for those improved conditions
Summary
Ghana has experienced considerable evolution in its healthcare financing. After independence, direct out-of-pocket consumption of healthcare in public health facilities was abolished [1]. Financing of health in the public sector was entirely dependent on tax revenues [1]. The sustainability of this form of healthcare financing became uncertain as Ghana’s economy began to experience considerable downturn, especially in the early 1980s [2]. This necessitated the “cash and carry” system. Its implementation compounded the utilization problem by creating financing barrier to healthcare access especially for the poor
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