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Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?

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  • Jehu-Appiah, Caroline
  • Aryeetey, Genevieve
  • Spaan, Ernst
  • de Hoop, Thomas
  • Agyepong, Irene
  • Baltussen, Rob

Abstract

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.

Suggested Citation

  • 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.
  • Handle: RePEc:eee:socmed:v:72:y:2011:i:2:p:157-165
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    References listed on IDEAS

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    Citations

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    Cited by:

    1. Vincent Z. Kuuire & Eric Y. Tenkorang & Andrea Rishworth & Isaac Luginaah & Alfred E. Yawson, 2017. "Is the Pro-Poor Premium Exemption Policy of Ghana’s NHIS Reducing Disparities Among the Elderly?," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 36(2), pages 231-249, April.
    2. Sato, Azusa, 2012. "Do Inequalities in Health Care Utilization in Developing Countries Change When We Take into Account Traditional Medicines?," World Development, Elsevier, vol. 40(11), pages 2275-2289.
    3. Lisa Bagnoli, 2017. "Does National Health Insurance Improve Children's Health ?National and Regional Evidence from Ghana," Working Papers ECARES ECARES 2017-03, ULB -- Universite Libre de Bruxelles.
    4. 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, pages 103-112.
    5. Silfverberg, Denise Valerie, 2015. "Analysis of the Philippine Health Insurance Corporation's Individually Paying Program and Employed Program," Philippine Journal of Development PJD 2013 Vol. 40 Nos. 1-2, Philippine Institute for Development Studies.
    6. Mawuli Gaddah & Alistair Munro, 2011. "The Progressivity Of Health Care Services In Ghana," GRIPS Discussion Papers 11-14, National Graduate Institute for Policy Studies.
    7. Adu, Kofi Osei, 2014. "Low participation in national health insurance scheme in Central Region OF Ghana: underlying reasons and health seeking behaviour of both insured and uninsured," MPRA Paper 58411, University Library of Munich, Germany.
    8. Gajate-Garrido, Gissele & Ahiadeke, Clement, 2015. "The effect of insurance enrollment on maternal and child health care utilization: The case of Ghana," IFPRI discussion papers 1495, International Food Policy Research Institute (IFPRI).
    9. 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, pages 138-147.
    10. Paul Mosley & Abdul-Gafaru Abdulai, 2016. "The political economy of 'linked' progressive taxation in Africa and Latin America," WIDER Working Paper Series 131, World Institute for Development Economic Research (UNU-WIDER).
    11. Parmar, Divya & Williams, Gemma & Dkhimi, Fahdi & Ndiaye, Alfred & Asante, Felix Ankomah & Arhinful, Daniel Kojo & Mladovsky, Philipa, 2014. "Enrolment of older people in social health protection programs in West Africa – Does social exclusion play a part?," Social Science & Medicine, Elsevier, pages 36-44.

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