Inequalities in out-of-pocket health expenditure among women of reproductive age: after-effects of national health insurance scheme initiation in Ghana

Michael Ekholuenetale,Amadou Barrow

doi:10.1186/s42506-020-00064-9

Abstract

BackgroundImprovement in maternal healthcare is a public health priority. Unfortunately, in spite of the efforts made over time regarding universal coverage, there remain issues with accessibility and use of healthcare services up to now. In this study, we examined inequalities in out-of-pocket health expenditure among women of reproductive age in Ghana. We analyzed secondary data collected in Ghana Demographic and Health Survey (GDHS) - 2014. A total of 9,002 women of reproductive age were included in this study. Lorenz curves and the concentration index were used to examine neighborhood socioeconomic disadvantage inequalities in out-of-pocket expenditure for maternal healthcare utilizationResultsAbout two thirds (66.0%) of women of reproductive age in Ghana were covered by health insurance. In sum, women of high neighborhood socioeconomic disadvantage status had the least out-of-pocket expenditure for total healthcare utilization, laboratory investigations, antenatal care visits, post-natal care visits, care for new born for up to 3 months, and other healthcare services. The converse was however true for family planning service utilization. Using Concentration Index, we quantified the degree of neighborhood socioeconomic disadvantage inequalities in healthcare service utilizations.ConclusionThis study showed a gap in health insurance coverage among women of reproductive age. There were also inequalities in out-of-pocket expenditure for healthcare services utilization. It is expedient for stakeholders in the healthcare system to make policies targeted at bridging the neighborhood socioeconomic differences in maternal healthcare use and develop programs to improve women’s financial protection. Moreover, enlightenment on health insurance availability and coverage should focus on women at risk of out-of-pocket expenditure.

Highlights

Improvement in maternal healthcare is a public health priority
This shows that a gap of approximately one third of women is yet to be covered by health insurance scheme
Approximately 16.9% of women who had out-of-pocket expenditure for family planning services were in the lowest neighborhood socioeconomic disadvantage group; 32.3% of women being in the highest neighborhood socioeconomic disadvantage group had out-of-pocket expenditure for family planning services

Summary

Introduction

Improvement in maternal healthcare is a public health priority. in spite of the efforts made over time regarding universal coverage, there remain issues with accessibility and use of healthcare services up to now. There is a need for healthcare systems to establish financial protection for the populace against the burden of health problems It is against this backdrop that the World Health Assembly resolution 58.33 requested member states to target achievement of the UHC [6], through equality in access to healthcare services utilizations especially when required with no financial barriers. This involves multifacets strategies including the proportion of health costs covered, the range of services covered, and the proportion of people covered [2]

Methods

Results

Discussion

Conclusion