IDEAS home Printed from https://ideas.repec.org/a/sae/envirc/v29y2011i6p1102-1115.html
   My bibliography  Save this article

Ghana's National Health Insurance Scheme: Helping the Poor or Leaving Them Behind?

Author

Listed:
  • Jenna Dixon

    (Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON N6A 5C2, Canada)

  • Eric Y Tenkorang

    (Department of Sociology, Memorial University of Newfoundland, St John's Newfoundland, A1C 5S7, Canada)

  • Isaac Luginaah

    (Department of Geography, University of Western Ontario, 1151 Richmond Street, London, ON N6A 5C2, Canada)

Abstract

We present findings on the determinants of enrolment for Ghana's National Health Insurance Scheme (NHIS). With this study we contribute to the literature by providing one of the few quantitative analyses on a nationwide survey. Using data from the 2008 Ghana Demographic and Health Survey, we find that those from the poorest households remain significantly less likely to enrol in the NHIS compared with respondents from wealthy households, even after controlling for theoretically relevant variables. However, our analysis also shows that respondents in Northern Ghana, considered the poorest part of the country, are more likely to be enroled than those in Southern Ghana. The findings present a clear challenge to the original mandate of the NHIS as a propoor policy and suggest that health policy makers should consider expanding and clarifying the criteria for declaring a person as indigent and that the scheme be further evaluated for obstacles that may be hindering enrolment.

Suggested Citation

  • Jenna Dixon & Eric Y Tenkorang & Isaac Luginaah, 2011. "Ghana's National Health Insurance Scheme: Helping the Poor or Leaving Them Behind?," Environment and Planning C, , vol. 29(6), pages 1102-1115, December.
  • Handle: RePEc:sae:envirc:v:29:y:2011:i:6:p:1102-1115
    DOI: 10.1068/c1119r
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1068/c1119r
    Download Restriction: no

    File URL: https://libkey.io/10.1068/c1119r?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Koch, Steven & Alaba, Olufunke, 2010. "On health insurance and household decisions: A treatment effect analysis," Social Science & Medicine, Elsevier, vol. 70(2), pages 175-182, January.
    2. Joseph Mensah & Joseph R. Oppong & Christoph M. Schmidt, 2010. "Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 95-106, September.
    3. Pablo Gottret & George Schieber, 2006. "Health Financing Revisited : A Practitioner's Guide," World Bank Publications - Books, The World Bank Group, number 7094, December.
    4. Ayé, Marcellin & Champagne, François & Contandriopoulos, André-Pierre, 2002. "Economic role of solidarity and social capital in accessing modern health care services in the Ivory Coast," Social Science & Medicine, Elsevier, vol. 55(11), pages 1929-1946, December.
    5. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    6. Mariam, Damen Haile, 2003. "Indigenous social insurance as an alternative financing mechanism for health care in Ethiopia (the case of eders)," Social Science & Medicine, Elsevier, vol. 56(8), pages 1719-1726, April.
    7. McIntyre, Diane & Thiede, Michael & Dahlgren, Göran & Whitehead, Margaret, 2006. "What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?," Social Science & Medicine, Elsevier, vol. 62(4), pages 858-865, February.
    8. Denis Drechsler & Johannes Jütting, 2005. "Private Health Insurance for the Poor in Developing Countries?," OECD Development Centre Policy Insights 11, OECD Publishing.
    9. Abdo S. Yazbeck, 2009. "Attacking Inequality in the Health Sector : A Synthesis of Evidence and Tools," World Bank Publications - Books, The World Bank Group, number 2583, December.
    10. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & Agyepong, Irene & Baltussen, Rob, 2010. "Efficiency, equity and feasibility of strategies to identify the poor: An application to premium exemptions under National Health Insurance in Ghana," Health Policy, Elsevier, vol. 95(2-3), pages 166-173, May.
    11. Criel, Bart & Waelkens, Maria Pia, 2003. "Declining subscriptions to the Maliando Mutual Health Organisation in Guinea-Conakry (West Africa): what is going wrong?," Social Science & Medicine, Elsevier, vol. 57(7), pages 1205-1219, October.
    12. Veenstra, Gerry & Luginaah, Isaac & Wakefield, Sarah & Birch, Stephen & Eyles, John & Elliott, Susan, 2005. "Who you know, where you live: social capital, neighbourhood and health," Social Science & Medicine, Elsevier, vol. 60(12), pages 2799-2818, June.
    13. Tolhurst, Rachel & Amekudzi, Yaa Peprah & Nyonator, Frank K. & Bertel Squire, S. & Theobald, Sally, 2008. ""He will ask why the child gets sick so often": The gendered dynamics of intra-household bargaining over healthcare for children with fever in the Volta Region of Ghana," Social Science & Medicine, Elsevier, vol. 66(5), pages 1106-1117, March.
    14. Agyepong, Irene Akua & Nagai, Richard A., 2011. ""We charge them; otherwise we cannot run the hospital" front line workers, clients and health financing policy implementation gaps in Ghana," Health Policy, Elsevier, vol. 99(3), pages 226-233, March.
    15. Basaza, Robert & Criel, Bart & Van der Stuyft, Patrick, 2008. "Community health insurance in Uganda: Why does enrolment remain low? A view from beneath," Health Policy, Elsevier, vol. 87(2), pages 172-184, August.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Dassah, Ebenezer & Aldersey, Heather M. & McColl, Mary Ann & Davison, Colleen, 2018. "‘When I don't have money to buy the drugs, I just manage.’—Exploring the lived experience of persons with physical disabilities in accessing primary health care services in rural Ghana," Social Science & Medicine, Elsevier, vol. 214(C), pages 83-90.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dixon, Jenna & Luginaah, Isaac & Mkandawire, Paul, 2014. "The National Health Insurance Scheme in Ghana's Upper West Region: A gendered perspective of insurance acquisition in a resource-poor setting," Social Science & Medicine, Elsevier, vol. 122(C), pages 103-112.
    2. Khaled Makhloufi & Bruno Ventelou & Mohammad Abu-Zaineh, 2015. "Have health insurance reforms in Tunisia attained their intended objectives?," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 29-51, March.
    3. Stephen Kwasi Opoku Duku & Edward Nketiah-Amponsah & Wendy Janssens & Menno Pradhan, 2018. "Perceptions of healthcare quality in Ghana: Does health insurance status matter?," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-17, January.
    4. Igna Bonfrer & Lyn Breebaart & Ellen Van de Poel, 2016. "The Effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilization," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-13, November.
    5. Yilma, Zelalem & van Kempen, Luuk & de Hoop, Thomas, 2012. "A perverse ‘net’ effect? Health insurance and ex-ante moral hazard in Ghana," Social Science & Medicine, Elsevier, vol. 75(1), pages 138-147.
    6. Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.
    7. Osei Afriyie, Doris & Masiye, Felix & Tediosi, Fabrizio & Fink, Günther, 2023. "Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia," Social Science & Medicine, Elsevier, vol. 321(C).
    8. Robyn, Paul Jacob & Bärnighausen, Till & Souares, Aurélia & Traoré, Adama & Bicaba, Brice & Sié, Ali & Sauerborn, Rainer, 2014. "Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study," Social Science & Medicine, Elsevier, vol. 108(C), pages 223-236.
    9. Stephen K.O. Duku & Edward Nketiah-Amponsahd & Christine J. Fenenga & Daniel K. Arhinful & Wendy (W.) Janssens & Menno (M.) Pradhan, 2018. "The Effect of Community Engagement on Healthcare Utilization and Health Insurance Enrolment in Ghana Results from a Randomized Experiment," Tinbergen Institute Discussion Papers 18-017/V, Tinbergen Institute.
    10. Pedrazzoli, Debora & Carter, Daniel J. & Borghi, Josephine & Laokri, Samia & Boccia, Delia & Houben, Rein MGJ., 2021. "Does Ghana's National Health Insurance Scheme provide financial protection to tuberculosis patients and their households?," Social Science & Medicine, Elsevier, vol. 277(C).
    11. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    12. Maia Sieverding & Cynthia Onyango & Lauren Suchman, 2018. "Private healthcare provider experiences with social health insurance schemes: Findings from a qualitative study in Ghana and Kenya," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-22, February.
    13. David Mark Dror, 2018. "What Factors Affect Voluntary Uptake of Community-based Health Insurance Schemes in Lowand Middle-Income Countries? A Systematic Review and Meta-Analysis," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 14, pages 271-306, World Scientific Publishing Co. Pte. Ltd..
    14. Thomas Rouyard & Yukichi Mano & Bocar Mamadou Daff & Serigne Diouf & Khadidiatou Fall Dia & Laetitia Duval & Josselin Thuilliez & Ryota Nakamura, 2022. "Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal," Post-Print halshs-03641124, HAL.
    15. Osuchukwu Nelson C. & Osonwa Kalu O. & Eko Jimmy E. & Uwanede C. C. & Abeshi, S. E. & Offiong Dominic A., 2013. "Evaluating the Impact of National Health Insurance Scheme on Health Care Consumers in Calabar Metropolis, Southern Nigeria," International Journal of Learning and Development, Macrothink Institute, vol. 3(4), pages 30-45, August.
    16. Onah, Michael Nnachebe & Horton, Susan, 2018. "Male-female differences in households' resource allocation and decision to seek healthcare in south-eastern Nigeria: Results from a mixed methods study," Social Science & Medicine, Elsevier, vol. 204(C), pages 84-91.
    17. Gowokani Chijere Chirwa & Marc Suhrcke & Rodrigo Moreno-Serra, 2020. "The Impact of Ghana’s National Health Insurance on Psychological Distress," Applied Health Economics and Health Policy, Springer, vol. 18(2), pages 249-259, April.
    18. Onwujekwe, Obinna & Onoka, Chima & Uzochukwu, Benjamin & Okoli, Chijioke & Obikeze, Eric & Eze, Soludo, 2009. "Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria," Health Policy, Elsevier, vol. 92(1), pages 96-102, September.
    19. Sarah Alkenbrack & Magnus Lindelow, 2015. "The Impact of Community‐Based Health Insurance on Utilization and Out‐of‐Pocket Expenditures in Lao People's Democratic Republic," Health Economics, John Wiley & Sons, Ltd., vol. 24(4), pages 379-399, April.
    20. Mebratie, A.D. & Sparrow, R.A. & Debebe, Z.Y. & Alemu, G. & Bedi, A.S., 2014. "Dropping out of Ethiopia’s Community Based Health Insurance scheme," ISS Working Papers - General Series 76960, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:envirc:v:29:y:2011:i:6:p:1102-1115. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.