Abstract
This study’s objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare for both the insured and uninsured.
Highlights
BackgroundHealthcare financing in Sub-Saharan Africa (SSA) is a grim scenario
This study demonstrated that health insurance status matters in the perception of the nontechnical quality of healthcare in Ghana
The findings suggest that people’s perceptions of healthcare quality may be shaped by their actual experiences at the health facilities, and these experiences differ depending on their insurance status
Summary
BackgroundHealthcare financing in Sub-Saharan Africa (SSA) is a grim scenario. SSA comprises 12% of the world’s population and 22% of the total global disease burden [1], yet accounts for only 1% of the world’s health expenditure and 2% of the global workforce in healthcare. Countries in SSA, such as South Africa, Gabon, Mali, Senegal, Uganda, Tanzania, Nigeria, and Ghana have taken steps towards universal coverage by adopting risk pooling systems to provide financial protection, to the poor and vulnerable in their societies [5,6,7,8,9]. These risk-pooling systems are either small, community-based health insurance (CBHI) schemes or social health insurance (SHI) schemes. People’s perception about the NHIS and healthcare quality has been identified as one of the factors that informs their decision to enrol or drop out of the scheme [13,14]
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