Assessing the impoverishment effects of out-of-pocket healthcare payments prior to the uptake of the national health insurance scheme in Ghana

BMC International Health and Human Rights

Research Article

Di McIntyre¹  John Ele-Ojo Ataguba¹  Edmund Wedam Kanmiki²  Abraham Oduro²  James Akazili³  Osman Sankoh⁴  John Gyapong⁵ 

[1]Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa

[2]Navrongo Health Research Centre, Ghana Health Service, Box 114, Navrongo, Upper East Region, Ghana

[3]Navrongo Health Research Centre, Ghana Health Service, Box 114, Navrongo, Upper East Region, Ghana

[4]INDEPTH Network, P.O. Box KD 213, Kanda, Accra, Ghana

[5]School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

[6]University of Health and Allied Sciences, PMB 31, Ho, Ghana

关键词: Financial risk protection;    Impoverishment;    Out-of-pocket healthcare payments;    Health insurance;    Ghana;   

DOI  :  10.1186/s12914-017-0121-7

 received in 2016-05-30, accepted in 2017-05-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThere is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana’s national health insurance scheme.MethodsData come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen’s parade of “dwarfs and a few giants” is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana.ResultsThere was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones.ConclusionIt is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana’s national health insurance scheme on impoverishment due to OOP healthcare payments.

【 授权许可】

CC BY   
© The Author(s). 2017

【 图 表 】

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