Abstract
BackgroundAccess to health insurance is expected to have positive effect in improving access to healthcare and offer financial risk protection to households. Ghana began the implementation of a National Health Insurance Scheme (NHIS) in 2004 as a way to ensure equitable access to basic healthcare for all residents. After a decade of its implementation, national coverage is just about 34% of the national population. Affordability of the NHIS contribution is often cited by households as a major barrier to enrolment in the NHIS without any rigorous analysis of this claim. In light of the global interest in achieving universal health insurance coverage, this study seeks to examine the extent to which affordability of the NHIS contribution is a barrier to full insurance for households and a burden on their resources.MethodsThe study uses data from a cross-sectional household survey involving 2,430 households from three districts in Ghana conducted between January-April, 2011. Affordability of the NHIS contribution is analysed using the household budget-based approach based on the normative definition of affordability. The burden of the NHIS contributions to households is assessed by relating the expected annual NHIS contribution to household non-food expenditure and total consumption expenditure. Households which cannot afford full insurance were identified.ResultsResults show that 66% of uninsured households and 70% of partially insured households could afford full insurance for their members. Enroling all household members in the NHIS would account for 5.9% of household non-food expenditure or 2.0% of total expenditure but higher for households in the first (11.4%) and second (7.0%) socio-economic quintiles. All the households (29%) identified as unable to afford full insurance were in the two lower socio-economic quintiles and had large household sizes. Non-financial factors relating to attributes of the insurer and health system problems also affect enrolment in the NHIS.ConclusionAffordability of full insurance would be a burden on households with low socio-economic status and large household size. Innovative measures are needed to encourage abled households to enrol. Policy should aim at abolishing the registration fee for children, pricing insurance according to socio-economic status of households and addressing the inimical non-financial factors to increase NHIS coverage.
Highlights
Access to health insurance is known to have positive effects in improving access to healthcare services and serves as a mechanism for avoiding catastrophic healthcare expenditures which often plunge low resourced householdsSince the mid 1990s, several Low-and middle-income countries (LMIC) have been implementing various types of health insurance programmes as a response to the global effort to move away from theKusi et al International Journal for Equity in Health (2015) 14:2 reliance on out-of-pocket payment for health towards risk-pooling and risk-sharing arrangements [1,2,3,6,7]
As was the trend in several African countries in the 1990s, Ghana began to witness the establishment of several community health insurance (CHI) schemes as part of what has been described as the ‘African CHI movement’ due to the rapidity of their growth on the continent [8,9]
Reasons for non-enrolment in the National Health Insurance Scheme (NHIS) The results show that about 64% (634) of the uninsured and 47% (128) of the partially insured households reported that their members were not insured with the NHIS because they considered the contributions to be expensive
Summary
Access to health insurance is known to have positive effects in improving access to healthcare services and serves as a mechanism for avoiding catastrophic healthcare expenditures which often plunge low resourced householdsSince the mid 1990s, several LMICs have been implementing various types of health insurance programmes as a response to the global effort to move away from theKusi et al International Journal for Equity in Health (2015) 14:2 reliance on out-of-pocket payment for health towards risk-pooling and risk-sharing arrangements [1,2,3,6,7]. In 2004, Ghana began the implementation of a National Health Insurance Scheme (NHIS) following the passage of the National Health Insurance Act (Act 650) in 2003. The NHIS has an overall goal of ensuring equitable access to quality basic healthcare for all residents, without having to make out-of-pocket payments at the point of service. 34% of Ghana’s population of 24.6 million are active members (i.e. valid card holding members) [10]. Ghana began the implementation of a National Health Insurance Scheme (NHIS) in 2004 as a way to ensure equitable access to basic healthcare for all residents. In light of the global interest in achieving universal health insurance coverage, this study seeks to examine the extent to which affordability of the NHIS contribution is a barrier to full insurance for households and a burden on their resources
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