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An assessment of out of pocket payments in public sector health facilities under the free maternal healthcare policy in Ghana

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Listed:
  • Maxwell Tii Kumbeni

    (Oregon State University)

  • Agani Afaya

    (Yonsei University
    University of Health and Allied Sciences)

  • Paschal Awingura Apanga

    (Kentucky Department for Public Health)

Abstract

Background The free maternal healthcare policy was introduced in Ghana in 2008 under the national health insurance scheme as a social intervention to improve access to maternal health services. This study investigated the prevalence of out of pocket (OOP) payment among pregnant women with valid national health insurance who sought skilled delivery services at public sector health facilities in Ghana. The study also assessed the health system factors associated with OOP payment. Methods We used data from the Ghana Maternal Health Survey (GMHS), which was conducted in 2017. The study comprised 7681 women who delivered at a public sector health facility and had valid national health insurance at the time of delivery. We used multivariable logistic regression analysis to assess factors associated with OOP payment, whiles accounting for clustering, stratification, and sampling weights. Results The prevalence of OOP payment for skilled delivery services was 19.0%. After adjustment at multivariable level, hospital delivery services (adjusted Odds Ratio [aOR] = 1.23, 95% Confidence Interval [CI] = 1.00, 1.52), caesarean section (aOR = 1.73, 95% CI = 1.36, 2.20), and receiving intravenous infusion during delivery (aOR = 1.31, 95% CI = 1.08, 1.60) were associated with higher odds of OOP payment. Women who were discharged home 2 to 7 days after delivery had 19% lower odds of OOP payment compared to those who were discharged within 24 hours after delivery. Conclusion This study provides evidence of high prevalence of OOP payment among women who had skilled delivery services in public sector health facilities although such women had valid national health insurance. Government may need to institute measures to reduce OOP payment in public sector facilities especially at the hospitals and for women undergoing caesarean sections.

Suggested Citation

  • Maxwell Tii Kumbeni & Agani Afaya & Paschal Awingura Apanga, 2023. "An assessment of out of pocket payments in public sector health facilities under the free maternal healthcare policy in Ghana," Health Economics Review, Springer, vol. 13(1), pages 1-7, December.
    • Handle: RePEc:spr:hecrev:v:13:y:2023:i:1:d:10.1186_s13561-023-00423-0
    DOI: 10.1186/s13561-023-00423-0
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    1. repec:zbw:rwirep:0157 is not listed on IDEAS
    2. Joseph Mensah & Joseph R. Oppong & Christoph M. Schmidt, 2010. "Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 95-106, September.
    3. Sanni Yaya & Feng Da & Ruoxi Wang & Shangfeng Tang & Bishwajit Ghose, 2019. "Maternal healthcare insurance ownership and service utilisation in Ghana: Analysis of Ghana Demographic and Health Survey," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-13, April.
    4. Philip Ayizem Dalinjong & Alex Y. Wang & Caroline S. E. Homer, 2017. "The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana," Health Economics Review, Springer, vol. 7(1), pages 1-9, December.
    5. Moses Aikins & Philip Teg-Nefaah Tabong & Paola Salari & Fabrizio Tediosi & Francis M Asenso-Boadi & Patricia Akweongo, 2021. "Positioning the National Health Insurance for financial sustainability and Universal Health Coverage in Ghana: A qualitative study among key stakeholders," PLOS ONE, Public Library of Science, vol. 16(6), pages 1-16, June.
    6. Monica Lambon-Quayefio & Nkechi S. Owoo, 2017. "Determinants and the impact of the National Health Insurance on neonatal mortality in Ghana," Health Economics Review, Springer, vol. 7(1), pages 1-16, December.
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