The National Health Insurance Scheme in Ghana's Upper West Region: A gendered perspective of insurance acquisition in a resource-poor setting
Ghana's National Health Insurance Scheme (NHIS) was designed as a pro-poor strategy to create wider access to health care. While recent studies have shown that wealth is an important factor in enrolment in the scheme, there is little understanding of its interlinkages with the geographical divisions and deep-seated deprivation in the northern region. In response to the nexus of poverty, gender and access to health care, this research took place in Ghana's Upper West Region (UWR), one of the poorest regions and yet paradoxically touting the highest enrolment rates. Using data from a population survey (n = 2119) collected between May to December 2011, we used multinomial regression to examine factors that influence enrolment, controlling for theoretically relevant covariates. Findings reveal that although wealth and desire for health insurance are contributing factors, education was the primary determinant in both never enrolling and in dropping out, and that these factors impact men and women differently. The study also shows that Muslims were less likely to enrol and also women living in non-nuclear households were far more likely to dropout. Our results demonstrate clear gendered divisions in accessing the NHIS, and raised serious equity concerns in the UWR. By focussing on the context of the UWR, we show the importance of understanding intra-household bargaining and resource allocation via the gender dynamics related to health insurance procurement and maintenance, and discuss associated policy implications.
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Volume (Year): 122 (2014)
Issue (Month): C ()
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- 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.
- William C. Hsiao & R. Paul Shaw, 2007. "Social Health Insurance for Developing Nations," World Bank Publications, The World Bank, number 6860.
- Gyimah, Stephen Obeng & Takyi, Baffour K. & Addai, Isaac, 2006. "Challenges to the reproductive-health needs of African women: On religion and maternal health utilization in Ghana," Social Science & Medicine, Elsevier, vol. 62(12), pages 2930-2944, June.
- Avotri, Joyce Yaa & Walters, Vivienne, 1999. "''You just look at our work and see if you have any freedom on earth'': Ghanaian women's accounts of their work and their health," Social Science & Medicine, Elsevier, vol. 48(9), pages 1123-1133, May.
- Sahn, David E. & Stifel, David C., 2000. "Poverty Comparisons Over Time and Across Countries in Africa," World Development, Elsevier, vol. 28(12), pages 2123-2155, December.
- Buor, Daniel, 2004. "Gender and the utilisation of health services in the Ashanti Region, Ghana," Health Policy, Elsevier, vol. 69(3), pages 375-388, September.
- De Allegri, Manuela & Sanon, Mamadou & Bridges, John & Sauerborn, Rainer, 2006. "Understanding consumers' preferences and decision to enrol in community-based health insurance in rural West Africa," Health Policy, Elsevier, vol. 76(1), pages 58-71, March.
- Al-Hassan, Ramatu M. & Diao, Xinshen, 2007.
"Regional disparities in Ghana: Policy options and public investment implications,"
GSSP working papers
2, International Food Policy Research Institute (IFPRI).
- Al-Hassan, Ramatu M. & Diao, Xinshen, 2007. "Regional disparities in Ghana: Policy options and public investment implications," IFPRI discussion papers 693, International Food Policy Research Institute (IFPRI).
- Barrett, Hazel & Browne, Angela, 1996. "Health, hygiene and maternal education: Evidence from The Gambia," Social Science & Medicine, Elsevier, vol. 43(11), pages 1579-1590, December.
- 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.
- Alma Cohen & Peter Siegelman, 2010. "Testing for Adverse Selection in Insurance Markets," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 77(1), pages 39-84.
- Alma Cohen & Peter Siegelman, 2009. "Testing for Adverse Selection in Insurance Markets," NBER Working Papers 15586, National Bureau of Economic Research, Inc.
- Nikièma, Béatrice & Haddad, Slim & Potvin, Louise, 2008. "Women Bargaining to Seek Healthcare: Norms, Domestic Practices, and Implications in Rural Burkina Faso," World Development, Elsevier, vol. 36(4), pages 608-624, April.
- Porter, Gina, 2002. "Living in a Walking World: Rural Mobility and Social Equity Issues in Sub-Saharan Africa," World Development, Elsevier, vol. 30(2), pages 285-300, February.
- 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.
- Doyal, Lesley, 2000. "Gender equity in health: debates and dilemmas," Social Science & Medicine, Elsevier, vol. 51(6), pages 931-939, September.
- Michael M. Lokshin & Elena Glinskaya & Marito Garcia, 2004. "The Effect of Early Childhood Development Programmes on Women's Labour Force Participation and Older Children's Schooling in Kenya," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 13(2), pages 240-276, June.
- Frost, Michelle Bellessa & Forste, Renata & Haas, David W., 2005. "Maternal education and child nutritional status in Bolivia: finding the links," Social Science & Medicine, Elsevier, vol. 60(2), pages 395-407, January.
- Lim, Sung Soo & Winter-Nelson, Alex & Arends-Kuenning, Mary, 2007. "Household Bargaining Power and Agricultural Supply Response: Evidence from Ethiopian Coffee Growers," World Development, Elsevier, vol. 35(7), pages 1204-1220, July.
- Moss, Nancy E., 2002. "Gender equity and socioeconomic inequality: a framework for the patterning of women's health," Social Science & Medicine, Elsevier, vol. 54(5), pages 649-661, March.
- Rick L. Williams, 2000. "A Note on Robust Variance Estimation for Cluster-Correlated Data," Biometrics, The International Biometric Society, vol. 56(2), pages 645-646, June.
- 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.
- World Bank, 2013. "Africa Development Indicators 2012/13," World Bank Publications, The World Bank, number 13504.
- Haddad, Lawrence & Hoddinott, John, 1994. "Women's income and boy-girl anthropometric status in the Cote d'Ivoire," World Development, Elsevier, vol. 22(4), pages 543-553, April.
- Paul Glewwe, 1999. "Why Does Mother's Schooling Raise Child Health in Developing Countries? Evidence from Morocco," Journal of Human Resources, University of Wisconsin Press, vol. 34(1), pages 124-159.
- Awudu Abdulai & Christopher L. Delgado, 1999. "Determinants of Nonfarm Earnings of Farm-Based Husbands and Wives in Northern Ghana," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 81(1), pages 117-130. Full references (including those not matched with items on IDEAS)
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