Abstract
BackgroundGhana’s National Health Insurance Scheme (NHIS) was introduced in 2005 as a demand side intervention to remove financial barriers to accessing health services. After almost a decade of implementation, this study aims to investigate the association of NHIS membership with antenatal visits (ANC), postnatal visits (PNC) and under-five mortality, using data from the most recent Multiple Indicator Cluster Survey (MICS).MethodsThe survey was nationally representative and used a two-stage sample design to produce separate estimates for key indicators for each of the ten regions in Ghana. A generalised linear model (GLM) with binomial-family logit-link was used to estimate the effect of NHIS membership on each of the MNCH service utilisation indicators, adjusting for relevant confounding factors. Using birth history data, the Cox proportional hazard regression model was used to estimate the effect of NHIS membership on the incidence of under-five deaths, adjusted for wealth quintiles and other potential confounders.ResultsThe results support the role of health insurance membership in improving access to maternal and child health services, including antenatal care (ANC4+ adjusted OR = 1.94; 95 % CI = [1.28, 2.95]; P < 0.01), and content of antenatal care (adjusted OR = 2.05; 95 % CI = (1.46, 2.90); P < 0.0001). However, the study failed to show evidence of association of NHIS membership and under-five mortality (adjusted hazard rate = 0.86; 95 % CI = [0.64, 1.14]; P = 0.30).ConclusionsNational health insurance membership is associated with increased access to and utilisation of health care but not with under-five mortality.
Highlights
Ghana’s National Health Insurance Scheme (NHIS) was introduced in 2005 as a demand side intervention to remove financial barriers to accessing health services
The choice of using Multiple Indicator Cluster Survey (MICS) 2011 data was made to allow for a sufficient time period after the introduction of NHIS, yielding a greater likelihood of observing its potential effects on maternal and child health service utilisation and outcomes
The results showed that the poorest 20 % were least covered (38 %) by the national health insurance compared with the richest quintile (44 %), the observed difference is likely to be due to chance (P = 0.19)
Summary
Ghana’s National Health Insurance Scheme (NHIS) was introduced in 2005 as a demand side intervention to remove financial barriers to accessing health services. It is known that increasing women’s access to skilled delivery care, and children’s access to evidence based health interventions effectively protect the mother and child from illness and death. Conscious of this evidence, the Ghana Ministry of Health adopted several strategies to facilitate access to health services [2, 3]. Sulzbach [11] compared data in two districts in Ghana before (in 2004) and after NHIS implementation (in 2007) and found evidence of an increase in access to formal care among NHIS members as well as a significant decrease in health care expenditure They found no evidence of a difference in maternal care between women who enrolled in NHIS and those who did not
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