Refusal to enrol in Ghana’s National Health Insurance Scheme: is affordability the problem?

International Journal for Equity in Health

Felix A Asante¹  Kristian S Hansen³  Ulrika Enemark²  Anthony Kusi¹ 

[1] Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra, Ghana;Section for Health Promotion and Health Services Research, Department of Public Health, Faculty of Health, Aarhus University, Vennelyst Boulevard 6, Arhus C, 8000, Denmark;Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK

关键词: Ghana;    Affordability;    Premium;    Enrolment;    Universal coverage;    Voluntary health insurance;   

Others  :  1139403
DOI  :  10.1186/s12939-014-0130-2

 received in 2014-01-18, accepted in 2014-12-10,  发布年份 2015

【 摘 要 】

Background

Access 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.

Methods

The 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 wereidentified.

Results

Results 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.

Conclusion

Affordability 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.

【 授权许可】

   
2015 Kusi et al.; licensee BioMed Central.

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