Abstract
BackgroundGhana introduced a national health insurance program in 2005 with the goal of removing user fees, popularly called “cash and carry”, along with their associated catastrophic and impoverishment effects on the population and ensuring access to equitable health care. However, after a decade of implementation, the impact of this program on user fees and out-of-pocket payment (OOP) is not properly documented. This paper contributes to understanding the impact of Ghana’s health insurance program on out-of-pocket healthcare payments and the factors associated with the level of out-of-pocket payments for primary healthcare in a predominantly rural region of Ghana.MethodsUsing a five-year panel data of revenues accruing to public primary health facilities in seven districts, We employed mean comparison tests (t-test) to examine the trend in revenues accruing from out-of-pocket payments vis-à-vis health insurance claims for health services, medication, and obstetric care. Furthermore, generalized estimation equation regression models were used to assess the relationship between explanatory variables and the level of out-of-pocket payments and health insurance claims.ResultsOut-of-pocket payment for health services and medications declined by 63% and 62% respectively between 2010 and 2014. Insurance claims however increased by 16% within the same period. There was statistically a significant mean reduction in out-of-pocket payment over the period. Factors significantly associated with out-of-pocket payments in a given district are the number of community health facilities, availability of a district hospital and the year of observation.ConclusionThe study provides evidence that Ghana’s national health insurance program is significantly contributing to a reduction in out-of-pocket payment for primary healthcare in public health facilities. Efforts should therefore be put in place to ensure the sustainability of this policy as a major pathway for achieving universal health coverage in Ghana.
Highlights
The United Nations Sustainable Development Goals (SDGs) reinforce the need for national policies that ensure the financial risk protection of their citizens against the cost of unforeseen ill-health
Out-of-pocket payment for health services and medications declined by 63% and 62% respectively between 2010 and 2014
Factors significantly associated with out-of-pocket payments in a given district are the number of community health facilities, availability of a district hospital and the year of observation
Summary
The United Nations Sustainable Development Goals (SDGs) reinforce the need for national policies that ensure the financial risk protection of their citizens against the cost of unforeseen ill-health. Direct out-of-pocket healthcare payments have detrimental effects on the allocation of household disposable income for basic needs such as food, shelter, clothing, education and utilities among others [3, 4] This creates the need for health systems to ensure financial protection of individuals and households against the economic burden of ill health. The World Health Assembly resolution (WHA) 58.33 called on member countries to commit to attaining UHC [5] by ensuring that all people have access to healthcare services when needed without financial impediments. It encompasses three dimensions: the proportion of people covered, the range of services covered and the proportion of health costs covered [2, 6]. This paper contributes to understanding the impact of Ghana’s health insurance program on out-of-pocket healthcare payments and the factors associated with the level of out-of-pocket payments for primary healthcare in a predominantly rural region of Ghana
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