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Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: a cross-sectional study

Author

Listed:
  • Eric Nsiah-Boateng

    (University of Ghana
    National Health Insurance Authority)

  • Justice Nonvignon

    (University of Ghana)

  • Genevieve Cecelia Aryeetey

    (University of Ghana)

  • Paola Salari

    (Swiss Tropical and Public Health Institute
    University of Basel)

  • Fabrizio Tediosi

    (Swiss Tropical and Public Health Institute
    University of Basel)

  • Patricia Akweongo

    (University of Ghana)

  • Moses Aikins

    (University of Ghana)

Abstract

Background Earlier studies have found significant associations between sociodemographic factors and enrolment in the National Health Insurance Scheme (NHIS) in Ghana. These studies were mainly household surveys in relatively rural areas with high incidence of poverty. To expand the scope of existing evidence, this paper examines policy design factors associated with enrolment and dropout of the scheme in an urban poor district using routine secondary data. Methods This study is a cross-sectional quantitative analysis of 2014–2016 NHIS enrolment data of the Ashiedu Keteke district office. Descriptive and multivariate logistic regression analyses were performed to examine sociodemographic factors associated with NHIS enrolment and dropout. Results A total of 215,724 individuals enrolled in the NHIS over the period under study, of which 98,232 (46%) were new members. About 41% of existing members in 2014 dropped out of the NHIS in 2015 and 53% of those in 2015 dropped out in 2016. The indigents (core poor) are significantly more likely to enrol and to drop out of the NHIS. However, the males, informal sector employees, social security and national insurance trust (SSNIT) contributors, and the aged (70+ years) are significantly less likely to enrol in the NHIS but more likely to retain coverage. Conclusions A considerable number of members are dropping out of the NHIS. The indigents in particular, are increasingly enrolling in and dropping out of the NHIS whilst the males, informal sector employees, SSNIT contributors and the aged are not enrolling as expected but increasingly retaining coverage. Policy reforms to ensuring continued growth towards realization of universal health coverage should take these factors into consideration.

Suggested Citation

  • Eric Nsiah-Boateng & Justice Nonvignon & Genevieve Cecelia Aryeetey & Paola Salari & Fabrizio Tediosi & Patricia Akweongo & Moses Aikins, 2019. "Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: a cross-sectional study," Health Economics Review, Springer, vol. 9(1), pages 1-9, December.
    • Handle: RePEc:spr:hecrev:v:9:y:2019:i:1:d:10.1186_s13561-019-0241-y
    DOI: 10.1186/s13561-019-0241-y
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    References listed on IDEAS

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    1. Guy Carrin, 2002. "Social health insurance in developing countries: A continuing challenge," International Social Security Review, John Wiley & Sons, vol. 55(2), pages 57-69.
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    Cited by:

    1. Kwame Adjei-Mantey & Charles Yuji Horioka, 2023. "Determinants of health insurance enrollment and health expenditure in Ghana: an empirical analysis," Review of Economics of the Household, Springer, vol. 21(4), pages 1269-1288, December.

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