Insured clients out-of-pocket payments for health care under the national health insurance scheme in Ghana

Patricia Akweongo,Paola Salari,Moses Aikins,Kaspar Wyss,Fabrizio Tediosi

doi:10.1186/s12913-021-06401-8

Abstract

BackgroundIn 2003, Ghana implemented a National Health Insurance Scheme (NHIS) designed to promote universal health coverage and equitable access to health care. The scheme has largely been successful, yet it is confronted with many challenges threatening its sustainability. Out-of-pocket payments (OOP) by insured clients is one of such challenges of the scheme. This study sought to examine the types of services OOP charges are made for by insured clients and how much insured clients pay out-of-pocket.MethodsThis was a descriptive cross-sectional health facility survey. A total of 2066 respondents were interviewed using structured questionnaires at the point of health care exit in the Ashanti, Northern and Central regions of Ghana. Health facilities of different levels were selected from 3 districts in each of the three regions. Data were collected between April and June 2018. Using Epidata and STATA Version 13.1 data analyses were done using multiple logistic regression and simple descriptive statistics and the results presented as proportions and means.ResultsOf all the survey respondents 49.7% reported paying out-of-pocket for out-patient care while 46.9% of the insured clients paid out-of-pocket. Forty-two percent of the insured poorest quintile also paid out-of-pocket. Insured clients paid for consultation (75%) and drugs (63.2%) while 34.9% purchased drugs outside the health facility they visited. The unavailability of drugs (67.9%) and drugs not covered by the NHIS (20.8%) at the health facility led to out-of-pocket payments. On average, patients paid GHS33.00 (USD6.6) out-of-pocket. Compared to the Ashanti region, patients living in the Northern region were 74% less at odds to pay out-of-pocket for health care.Conclusion and recommendationInsured clients of Ghana’s NHIS seeking health care in accredited health facilities make out-of-pocket payments for consultation and drugs that are covered by the scheme. The out-of-pocket payments are largely attributed to unavailability of drugs at the facilities while the consultation fees are charged to meet the administrative costs of services. These charges occur in disadvantaged regions and in all health facilities. The high reliance on out-of-pocket payments can impede Ghana’s progress towards achieving Universal Health Coverage and the Sustainable Development Goal 3, seeking to end poverty and reduce inequalities. In order to build trust and confidence in the NHIS there is the need to eliminate out-of-pocket payments for consultation and medicines by insured clients.

Highlights

In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) designed to promote universal health coverage and equitable access to health care
The demand for social protection schemes as a way of mitigating against the effect of out-of-pocket payments and poverty is growing as social protection schemes prove successful in fighting against poverty
The question remains, what type of services are these unauthorized charges being made, who pays these charges and how much do they pay out-of-pocket?. Study design This was a descriptive cross-sectional exit health facility survey. It was conducted among patients accessing outpatient care services at different levels of the health system in three regions of Ghana

Summary

Introduction

In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) designed to promote universal health coverage and equitable access to health care. Half of the world’s population cannot still obtain essential health services and about 800 million people spend about 10% of their household budget on health care expenses, while over 100 million are further pushed into extreme poverty by paying for care out-ofpocket [1]. The proportion of households and patients paying-out-of-pocket for care is growing with about 808 million people estimated globally to have incurred catastrophic health spending in 2010 [1]. This continues to impose huge financial risks on households, especially vulnerable households, potentially pushing such households into a vicious cycle of poverty. The demand for social protection schemes as a way of mitigating against the effect of out-of-pocket payments and poverty is growing as social protection schemes prove successful in fighting against poverty

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