IDEAS home Printed from https://ideas.repec.org/
MyIDEAS: Log in (now much improved!) to save this article

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

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

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.

If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(10)00774-4
Download Restriction: Full text for ScienceDirect subscribers only

As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 72 (2011)
Issue (Month): 2 (January)
Pages: 157-165

as
in new window

Handle: RePEc:eee:socmed:v:72:y:2011:i:2:p:157-165
Contact details of provider: Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description

Order Information: Postal: http://www.elsevier.com/wps/find/supportfaq.cws_home/regional
Web: http://www.elsevier.com/orderme/journalorderform.cws_home/315/journalorderform1/orderooc/id=654&ref=654_01_ooc_1&version=01

References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

as in new window
  1. 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.
  2. 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.
  3. Schneider, Pia, 2005. "Trust in micro-health insurance: an exploratory study in Rwanda," Social Science & Medicine, Elsevier, vol. 61(7), pages 1430-1438, October.
  4. 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.
  5. Kroeger, Axel, 1983. "Anthropological and socio-medical health care research in developing countries," Social Science & Medicine, Elsevier, vol. 17(3), pages 147-161, January.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Abdo S. Yazbeck, 2009. "Attacking Inequality in the Health Sector : A Synthesis of Evidence and Tools," World Bank Publications, The World Bank, number 2583, July.
  11. Stock, Robert, 1983. "Distance and the utilization of health facilities in rural Nigeria," Social Science & Medicine, Elsevier, vol. 17(9), pages 563-570, January.
Full references (including those not matched with items on IDEAS)

This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:72:y:2011:i:2:p:157-165. See general information about how to correct material in RePEc.

For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Shamier, Wendy)

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 references are entirely missing, you can add them using this form.

If the full references list an item that is present in RePEc, but the system did not link 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 profile, as there may be some citations waiting for confirmation.

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

This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.