Abstract
BackgroundGhana’s National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme. While the scheme strives to achieve universal health coverage, this quest is derailed by negative perceptions of the quality of services rendered to NHIS subscribers. This paper presents an analysis on perceptions of service quality provided to subscribers of Ghana’s NHIS with emphasis on rural and urban scheme policy holders, using a nationally representative data.MethodsThe study used data from the 2014 Ghana Demographic and Health Survey. Ordered logistic regressions were estimated to identify the correlates of perceived quality of care of services rendered by the NHIS. Also, chi-square statistics were performed to test for significant differences in the proportions of subscribers in the two subsamples (rural and urban).ResultsRural subscribers of the NHIS were found to identify more with better perception of quality of services provided by the NHIS than urban subscribers. Results from the chi-square statistics further indicated that rural subscribers are significantly different from urban subscribers in terms of the selected socioeconomic and demographic characteristics. In the full sample; age, out-of-pocket payment for healthcare and region of residence proved significant in explaining perceived quality of services rendered by the NHIS. Age, out-of-pocket payment for healthcare, region of residence, wealth status, and access to media were found to be significant predictors of perceived quality of services provided to both rural and urban subscribers of the NHIS. The significance of these variables varied among men and women in rural and urban areas.ConclusionDifferent factors affect the perception of quality of services provided to rural and urban subscribers of Ghana’s NHIS. Health financing policies geared toward improving the NHIS-related services in rural and urban areas should be varied.
Highlights
Ghana’s National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme
It suggests that subscribers in rural Ghana on average have better perception of the quality of services provided by the NHIS than subscribers in urban Ghana
39 and 27% of urban subscribers compared with 28 and 41% of rural subscribers perceived the quality of NHIS services as worse and better respectively
Summary
Ghana’s National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme. While the scheme strives to achieve universal health coverage, this quest is derailed by negative perceptions of the quality of services rendered to NHIS subscribers. This paper presents an analysis on perceptions of service quality provided to subscribers of Ghana’s NHIS with emphasis on rural and urban scheme policy holders, using a nationally representative data. The government of Ghana has over the past one and a half decades intensified its quest to achieve universal health coverage. The scheme obligates all Ghanaian citizens and residents of Ghana to subscribe to a health insurance scheme as enshrined in the NHIS amended Act 852 (2012) [1]. The funding sources encompass a 2.5% (value added tax) National Health Insurance Levy (NHIL), return on National Health Insurance Fund Investment; premium fees, donations and contributions to the Social Security and National Insurance Trust
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