Abstract
This study’s objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare for both the insured and uninsured.
Original language | English |
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Article number | e0190911 |
Pages (from-to) | 1-17 |
Number of pages | 17 |
Journal | PLoS ONE |
Volume | 13 |
Issue number | 1 |
DOIs | |
Publication status | Published - 16 Jan 2018 |
Funding
This study received financial support from The Netherlands government through the Ministry of Foreign Affairs and the Science for Global Development (WOTRO) which is a division of the Netherlands Organization for Scientific Research (NWO), under the Global Health Policy and Systems Research (GHPHSR) programme (Project no. W07.45.104.00). Financial support for the field data collection and analysis was provided by NWO/WOTRO Ghana project (No. 0029) in the Netherlands. The authors acknowledge the Noguchi Memorial Institute for Medical Research (NMIMR); National Health Insurance Authority (NHIA), Ghana; Ministry of Health (MoH)/Ghana Health Service (GHS); and, the Christian Health Association of Ghana (CHAG) for their support in the data collection process for the study.
Funders | Funder number |
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Ministry of Health | |
Ministry of Foreign Affairs |