Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?
To improve equity in the provision of health care and provide risk protection to poor households, low-income countries are increasingly moving to social health insurance. Using data from a household survey of 3301 households conducted in 2009 this study aims to evaluate equity in enrollment in the National Health Insurance Scheme (NHIS) in Ghana and assess determinants of demand across socio-economic groups. Specifically by looking at how different predisposing (age, gender, education, occupation, family size, marital status, peer pressure and health beliefs etc) enabling (income, place of residence) need (health status) and social factors (perceptions) affect household decision to enrol and remain in the NHIS. Equity in enrollment is assessed by comparing enrollment between consumption quintiles. Determinants of enrolling in and dropping out from NHIS are assessed using a multinomial logit model after using PCA to evaluate respondent's perceptions relating to schemes, providers and community health 'beliefs and attitudes'. We find evidence of inequity in enrollment in the NHIS and significant differences in determinants of current and previous enrollment across socio-economic quintiles. Both current and previous enrollment is influenced by predisposing, enabling and social factors. There are, however, clear differences in determinants of enrollment between the rich and the poor. Policy makers need to recognize that extending enrollment will require recognition of all these complex factors in their design of interventions to stimulate enrollment.
Volume (Year): 72 (2011)
Issue (Month): 2 (January)
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- Nemet, Gregory F. & Bailey, Adrian J., 2000. "Distance and health care utilization among the rural elderly," Social Science & Medicine, Elsevier, vol. 50(9), pages 1197-1208, May.
- Abdo S. Yazbeck, 2009. "Attacking Inequality in the Health Sector : A Synthesis of Evidence and Tools," World Bank Publications, The World Bank, number 2583, August.
- Stock, Robert, 1983. "Distance and the utilization of health facilities in rural Nigeria," Social Science & Medicine, Elsevier, vol. 17(9), pages 563-570, January.
- Ronald J. Angel & Sonia M. Frias & Terrence D. Hill, 2005. "Determinants of Household Insurance Coverage Among Low-Income Families from Boston, Chicago, and San Antonio: Evidence from the Three-City Study," Social Science Quarterly, Southwestern Social Science Association, vol. 86(s1), pages 1338-1353.
- Schneider, Pia, 2005. "Trust in micro-health insurance: an exploratory study in Rwanda," Social Science & Medicine, Elsevier, vol. 61(7), pages 1430-1438, October.
- Criel, Bart & Van der Stuyft, Patrick & Van Lerberghe, Wim, 1999. "The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns," Social Science & Medicine, Elsevier, vol. 48(7), pages 897-911, April.
- Kroeger, Axel, 1983. "Anthropological and socio-medical health care research in developing countries," Social Science & Medicine, Elsevier, vol. 17(3), pages 147-161, January.
- 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.
- Jutting, Johannes P., 2004. "Do Community-based Health Insurance Schemes Improve Poor People's Access to Health Care? Evidence From Rural Senegal," World Development, Elsevier, vol. 32(2), pages 273-288, February.
- Alderman, Harold & Lavy, Victor, 1996. "Household Responses to Public Health Services: Cost and Quality Tradeoffs," World Bank Research Observer, World Bank Group, vol. 11(1), pages 3-22, February.
- Hengjin Dong & Adjima Gbangou & Manuela Allegri & Subhash Pokhrel & Rainer Sauerborn, 2008. "The differences in characteristics between health-care users and non-users: implication for introducing community-based health insurance in Burkina Faso," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(1), pages 41-50, February.
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