Determinants of health insurance enrolment in Ghana: evidence from three national household surveys.
Ghana
NHIS
determinants of enrolment
health insurance
household surveys
Journal
Health policy and planning
ISSN: 1460-2237
Titre abrégé: Health Policy Plan
Pays: England
ID NLM: 8610614
Informations de publication
Date de publication:
01 Oct 2019
01 Oct 2019
Historique:
accepted:
23
07
2019
pubmed:
23
8
2019
medline:
12
2
2020
entrez:
23
8
2019
Statut:
ppublish
Résumé
In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) to move towards Universal Health Coverage. NHIS enrolment is mandatory for all Ghanaians, but the most recent estimates show that coverage stands under 40%. The evidence on the relationship between socio-economic characteristics and NHIS enrolment is mixed, and comes mainly from studies conducted in a few areas. Therefore, in this study we investigate the socio-economic determinants of NHIS enrolment using three recent national household surveys. We used data from the Ghanaian Demographic and Health Survey conducted in 2014, the Multiple Indicator Cluster Survey conducted in 2011 and the sixth wave of the Ghana Living Standard Survey conducted in 2012-13. Given the multilevel nature of the three databases, we use multilevel logistic regression models to estimate the probability of enrolment for women and men separately. We used three levels of analysis: geographical clusters, household and individual units. We found that education, wealth, marital status-and to some extent-age were positively associated with enrolment. Furthermore, we found that enrolment was correlated with the type of occupation. The analyses of three national household surveys highlight the challenges of understanding the complex dynamics of factors contributing to low NHIS enrolment rates. The results indicate that current policies aimed at identifying and subsidizing underprivileged population groups might insufficiently encourage health insurance enrolment.
Identifiants
pubmed: 31435674
pii: 5552794
doi: 10.1093/heapol/czz079
pmc: PMC6794569
doi:
Types de publication
Journal Article
Langues
eng
Pagination
582-594Informations de copyright
© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
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