Treatment-seeking behaviour and social health insurance in Africa: the case of Ghana under the National Health Insurance Scheme.

Ama P Fenny,Ulrika Enemark,Felix A Asante,Kristian S Hansen

doi:10.5539/gjhs.v7n1p296

Abstract

Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy.The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah. Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries.

Highlights

Despite efforts to improve the provision of health services, many low- and middle-income countries are still far from achieving universal health coverage (World Health Report, 2010)
The results show that households from the fifth quintiles were more likely to have valid National Health Insurance Scheme (NHIS) card than households belonging to the first quintile
The results indicate that health insurance is a significant determinant of choice of provider

Summary

Introduction

Despite efforts to improve the provision of health services, many low- and middle-income countries are still far from achieving universal health coverage (World Health Report, 2010). A number of countries are trying to establish or broaden social insurance programmes to improve access to health care of their citizens (Wagstaff, 2009). Several low- and middle-income countries, including the Philippines, Thailand and Viet Nam, are establishing SHI (Spaan et al, 2012). In Sub Saharan Africa, countries such as Senegal, Rwanda, Tanzania, Kenya and Nigeria have implemented several variations of social health insurance schemes (Witter & Garshong, 2009; Nyantaki, 2009; Gobah et al 2011). An overview of the scope and origin of SHI in low- and middle-income countries concludes that the picture in Africa and Asia is very patchy, with large differences in population coverage, services covered and costs achieved (Soors et al, 2010). Senegal and Rwanda are among leading countries that have experimented with the idea of Community–based Health Insurance Schemes (CBHISs) as a national health program in Africa (Jutting, 2003)

Results

Discussion

Conclusion