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Do national health insurance schemes guarantee financial risk protection in the drive towards Universal Health Coverage in West Africa? A systematic review of observational studies

Author

Listed:
  • Sydney N N T Odonkor
  • Ferdinand Koranteng
  • Martin Appiah-Danquah
  • Lorena Dini

Abstract

To facilitate the drive towards Universal Health Coverage (UHC) several countries in West Africa have adopted National Health Insurance (NHI) schemes to finance health services. However, safeguarding insured populations against catastrophic health expenditure (CHE) and impoverishment due to health spending still remains a challenge. This study aims to describe the extent of financial risk protection among households enrolled under NHI schemes in West Africa and summarize potential learnings. We conducted a systematic review following the PRISMA guidelines. We searched for observational studies published in English between 2005 and 2022 on the following databases: PubMed/Medline, Web of Science, CINAHL, Embase and Google Scholar. We assessed the study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist. Two independent reviewers assessed the studies for inclusion, extracted data and conducted quality assessment. We presented our findings as thematic synthesis for qualitative data and Synthesis Without Meta-analysis (SWiM) for quantitative data. We published the study protocol in PROSPERO with ID CRD42022338574. Nine articles were eligible for inclusion, comprising eight cross-sectional studies and one retrospective cohort study published between 2011 and 2021 in Ghana (n = 8) and Nigeria (n = 1). While two-thirds of the studies reported a positive (protective) effect of NHI enrollment on CHE at different thresholds, almost all of the studies (n = 8) reported some proportion of insured households still encountered CHE with one-third reporting more than 50% incurring CHE. Although insured households seemed better protected against CHE and impoverishment compared to uninsured households, gaps in the current NHI design contributed to financial burden among insured populations. To enhance financial risk protection among insured households and advance the drive towards UHC, West African governments should consider investing more in NHI research, implementing nationwide compulsory NHI programmes and establishing multinational subregional collaborations to co-design sustainable context-specific NHI systems based on solidarity, equity and fair financial contribution.

Suggested Citation

  • Sydney N N T Odonkor & Ferdinand Koranteng & Martin Appiah-Danquah & Lorena Dini, 2023. "Do national health insurance schemes guarantee financial risk protection in the drive towards Universal Health Coverage in West Africa? A systematic review of observational studies," PLOS Global Public Health, Public Library of Science, vol. 3(8), pages 1-23, August.
    • Handle: RePEc:plo:pgph00:0001286
    DOI: 10.1371/journal.pgph.0001286
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    References listed on IDEAS

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    1. Runguo Wu & Niying Li & Angelo Ercia, 2020. "The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review," IJERPH, MDPI, vol. 17(6), pages 1-21, March.
    2. Ties Boerma & Patrick Eozenou & David Evans & Tim Evans & Marie-Paule Kieny & Adam Wagstaff, 2014. "Monitoring Progress towards Universal Health Coverage at Country and Global Levels," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-8, September.
    3. El-Sayed, Abdulrahman M. & Palma, Anton & Freedman, Lynn P. & Kruk, Margaret E., 2015. "Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries," Health Policy, Elsevier, vol. 119(9), pages 1164-1175.
    4. Bärnighausen, Till & Sauerborn, Rainer, 2002. "One hundred and eighteen years of the German health insurance system: are there any lessons for middle- and low-income countries?," Social Science & Medicine, Elsevier, vol. 54(10), pages 1559-1587, May.
    5. repec:plo:pone00:0225237 is not listed on IDEAS
    6. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    7. Priyanka Saksena & Justine Hsu & David B Evans, 2014. "Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-11, September.
    8. Carapinha, João L. & Ross-Degnan, Dennis & Desta, Abayneh Tamer & Wagner, Anita K., 2011. "Health insurance systems in five Sub-Saharan African countries: Medicine benefits and data for decision making," Health Policy, Elsevier, vol. 99(3), pages 193-202, March.
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