Abstract
BackgroundIn 2003, Ghana passed a law to establish a National Health Insurance Scheme (NHIS) to serve as the main vehicle for achieving universal health coverage. Over 60% of the population had registered by 2009. Current active membership is however 40%. The stagnation in growth has been recorded across all the membership categories. Clearly, the Scheme is falling short of its core objective. This analysis is a critical thematic contextual examination of the effects of demographic factors on enrolment onto the Scheme.MethodsDemographic secondary data for 625 respondents collected (using a structured questionnaire) during a cross-sectional household survey in an urban, Ashaiman, and rural, Adaklu, districts was analyzed in univariate and multivariate logistic regression models using Statistical Package for Social Scientists (SPSS). Statistical significance was set at P-value < 0.05. Variables included in the analysis were age, gender, education, occupation and knowledge about the NHIS.ResultsSeventy-nine percent of the survey respondents have ever enrolled onto the NHIS with three-fifths being females. Of the ever enrolled, 63% had valid cards. Age, gender and educational level were significant predictors of enrolment in the multivariate analysis. Respondents between the ages 41–60 years were twice (p = 0.05) more likely to be enrolled onto a district Scheme compared with respondents between the ages 21–40 years. Females were thrice (p = 0.00) more likely to enroll compared with males. Respondents educated to the tertiary, five times (p = 0.02), and post-graduate, four times (p = 0.05), levels were more likely to enroll compared with non-educated respondents. No significant association was observed between occupation and enrolment.ConclusionUptake of the scheme is declining despite high awareness and knowledge. Leadership, innovation and collaboration are required at the district Scheme level to curtail issues of low self-enrolment and to grow membership. Otherwise, the goal of universal coverage under the NHIS will become merely a slogan and equity in financial access to health care for all Ghanaians will remain elusive.
Highlights
In 2003, Ghana passed a law to establish a National Health Insurance Scheme (NHIS) to serve as the main vehicle for achieving universal health coverage
This study examined the effects of demographic factors on enrolment in two districts of Ghana
Seventy-nine percent of the survey respondents have ever enrolled onto the NHIS of which three-fifth were females
Summary
In 2003, Ghana passed a law to establish a National Health Insurance Scheme (NHIS) to serve as the main vehicle for achieving universal health coverage. The Scheme is falling short of its core objective. This analysis is a critical thematic contextual examination of the effects of demographic factors on enrolment onto the Scheme. Country level health care financing mechanisms are no longer only a matter of national level policy discourse and concerns, but have transcended into international development agendas as manifested in the Sustainable Development Goals (SDGs), and the Universal Health Coverage and Global Health movements [2,3,4]. Like most countries seeking to ensure the well-being of its citizens, Ghana has experimented with and introduced different models of health care financing. Benefits accruing to enrollees include medicines (mainly core drugs and specified in a list) and care services (both in-patient and out-patient) that has been estimated to cover 95% of all disease conditions in the country [6, 7]
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