Abstract
BackgroundEarlier studies have found significant associations between sociodemographic factors and enrolment in the National Health Insurance Scheme (NHIS) in Ghana. These studies were mainly household surveys in relatively rural areas with high incidence of poverty. To expand the scope of existing evidence, this paper examines policy design factors associated with enrolment and dropout of the scheme in an urban poor district using routine secondary data.MethodsThis study is a cross-sectional quantitative analysis of 2014–2016 NHIS enrolment data of the Ashiedu Keteke district office. Descriptive and multivariate logistic regression analyses were performed to examine sociodemographic factors associated with NHIS enrolment and dropout.ResultsA total of 215,724 individuals enrolled in the NHIS over the period under study, of which 98,232 (46%) were new members. About 41% of existing members in 2014 dropped out of the NHIS in 2015 and 53% of those in 2015 dropped out in 2016. The indigents (core poor) are significantly more likely to enrol and to drop out of the NHIS. However, the males, informal sector employees, social security and national insurance trust (SSNIT) contributors, and the aged (70+ years) are significantly less likely to enrol in the NHIS but more likely to retain coverage.ConclusionsA considerable number of members are dropping out of the NHIS. The indigents in particular, are increasingly enrolling in and dropping out of the NHIS whilst the males, informal sector employees, SSNIT contributors and the aged are not enrolling as expected but increasingly retaining coverage. Policy reforms to ensuring continued growth towards realization of universal health coverage should take these factors into consideration.
Highlights
Earlier studies have found significant associations between sociodemographic factors and enrolment in the National Health Insurance Scheme (NHIS) in Ghana
(2019) 9:23 in 166 districts across the country, and has a population coverage of 10.8 million (36%) and over 4000 network of healthcare providers as of December 2018 [13]. It is financed by 2.5% levy on selected goods and services, two and a half percentage points of workers’ contributions to the Social Security and National Insurance Trust (SSNIT), contributions from employees in the informal sector of the economy, approved funds by parliament, resources accrued to the National Health Insurance Fund (NHIF) from investments, and support from donor partners [12]
Trends in enrolment show that total enrolment and new enrolment assumed a downward trajectory after the base year (2014) (Fig. 1b)
Summary
Earlier studies have found significant associations between sociodemographic factors and enrolment in the National Health Insurance Scheme (NHIS) in Ghana. Nsiah-Boateng et al Health Economics Review (2019) 9:23 in 166 districts across the country, and has a population coverage of 10.8 million (36%) and over 4000 network of healthcare providers as of December 2018 [13] It is financed by 2.5% levy on selected goods and services, two and a half percentage points of workers’ contributions to the Social Security and National Insurance Trust (SSNIT), contributions from employees in the informal sector of the economy, approved funds by parliament, resources accrued to the National Health Insurance Fund (NHIF) from investments, and support from donor partners [12]. The National Health Insurance Authority (NHIA) which is the regulator of health insurance schemes in the country and an implementer of the NHIS, enrols LEAP beneficiaries in the scheme separately from the indigents This is done in collaboration with the Ministry of Gender, Children and Social Protection (MoGCSP). Despite the relatively low contributions and large groups of the population exempted from paying premium (close to 70% of the members), more than half of the population remains uninsured
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