Differences in the determinants of health insurance enrolment among working-age adults in two regions in Ghana

Stephen Kwasi Opoku Duku*

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Ghana's National Health Insurance Scheme (NHIS) has achieved varying levels of enrolment within the regions with different rural-urban populations with associated income inequalities. This study sought to investigate the differences in the determinants of enrolment between the Greater Accra (GAR) and Western (WR) regions of Ghana to inform the NHIS reforms. Method: Data from 4214 adults, 18 years and above from a household survey conducted in the two regions was analyzed. Bivariate analysis (t-test for continuous and Pearson chi-square for categorical) was performed to examine differences in respondents characteristics (socio-economic and insurance enrolment) between the two regions for the total, urban and rural samples. Logistic regression estimation was performed to establish differences in determinant of enrolment between the regions. Results: Age, sex, educational level, marital status, health status and travel time to nearest health facility were identified as determinants of enrolment in both regions and among the rural and urban residents within the regions. Although the rich and richest in both regions are more likely to enroll than the poor and poorest, the odds of enrolment for the urban richest in the WR is about twice that of GAR whiles the odds of enrolment for the rural richest in the GAR is also about twice that of the WR. Those who visit public facilities in the GAR are more likely to enroll than those in WR for the total and urban samples. However, those who visit private facilities in rural communities in both regions are more likely to enroll. Conclusion: Differences in the NHIS enrolment between the regions is as a result of differences in socio-economic factors that are intrinsic in the regions and impact on the inhabitants' ability to afford insurance premium. Policymakers should determine NHIS premium differently at the district level based on socio-economic activities and income levels within the districts.

Original languageEnglish
Article number384
Pages (from-to)1-16
Number of pages16
JournalBMC Health Services Research
Volume18
Issue number384
DOIs
Publication statusPublished - 29 May 2018

Funding

COHEiSION Project: Client-Oriented Health Insurance System in Ghana Project; GAR: Greater Accra Region; GSS: Ghana Statistical Service; NHIA: National Health Insurance Authority; NHIF: National Health Insurance Fund; NHIS: National Health Insurance Scheme; NOW: Netherlands Organization for Scientific Research; SSNIT: Social Security and National Insurance Trust; WHA: World Health Assembly; WOTRO: Science for Global Development; WR: Western Region I acknowledge the support of the Government of the Netherlands through the Netherlands Organization for Scientific Research (NWO/WOTRO) in the form of a research grant (Grant No. W07.45.104.00) for the COHEiSION project. I am most grateful to staff of the Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana and staff of the Faculty of Economics and Business Administration, Vrije Universiteit Amsterdam for their support in the project design. This study received financial support from the Government of the Netherlands through the Netherlands Organization for Scientific Research (NWO/WOTRO) in the form of a research grant (Grant No. W07.45.104.00) for the COHEiSION project. Collaborators of the study include Noguchi Memorial Institute for Medical Research, University of Ghana Legon; Amsterdam Institute for Global Health and Development, University of Amsterdam; Vrije University of Amsterdam and University of Groningen.

FundersFunder number
Greater Accra Region
National Health Insurance Authority
National Insurance Trust
WOTRO
National Health Insurance Administration
Nederlandse Organisatie voor Wetenschappelijk Onderzoek

    Keywords

    • Determinants of enrolment
    • Ghana
    • Health insurance
    • National Health Insurance Scheme
    • Rural-urban

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