Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

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

Author: Stephen Kwasi Opoku Duku

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

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.
Literature
1.
Carrin G, James C. Social health insurance: key factors affecting the transition towards universal coverage. Int Soc Secur Rev. 2005;58:1–15.CrossRef
2.
WHO. Sustainable health financing, universal coverage and social health insurance. In World Health Assembly Resolution: WHA58.33. Geneva: WHO; 2005.
3.
Griffin C. Health care in Asia: a comparative study of cost and financing. Washington: World Bank Regional and Sectoral Studies; 1992.
4.
GOG. The National Health Insurance Act: Act 650. Accra: Parliament House; 2003.
5.
6.
Addo JS. Consultants & tri Star actuarial and management consultant. A feasibility study for the establishment of a national health insurance scheme in Ghana. Accra: Ministry of Health; 1995.
7.
GOG. The national health insurance act: Act 852. Accra: Parliament House; 2012.
8.
NHIA. National health insurance authority 2013 annual report. Accra, Ghana: NHIA; 2014.
9.
NHIA. National health insurance authority 2011 annual report. Accra, Ghana: NHIA; 2012.
10.
GSS. 2010 population and housing census. Accra-Ghana: Ghana Statistical Service; 2012.
11.
12.
Akazili J, Welaga P, Bawah A, Achana FS, Oduro A, et al. Is Ghana’s pro-poor health insurance scheme really for the poor? Evidence from northern Ghana. BMC Health Serv Res. 2014;14:637.CrossRefPubMedPubMedCentral
13.
Cameron AC, Trivedi PK, Milne F, Piggott J. A micro-econometric model of the demand for health care and health insurance in Australia. Rev Econ Stud. 1988;55(1):85–106.CrossRef
14.
Asenso-Okyere W, Osei-Akoto I, Anum A, Appiah E. Willingness to pay for health insurance in a developing economy. A pilot study of the informal sector of Ghana using contingency valuation. Health Policy. 1997;42(3):223–37.CrossRefPubMed
15.
Sanhueza R, Ruiz-Tagle J. Choosing health insurance in a dual health care SYSTEM: the Chilean case. J Appl Econ. 5(1):157–84.
16.
Ying XH, Hu TW, Ren J, Chen W, Xu K, Huang JH. Demand for private health insurance in Chinese urban areas. Health Econ. 2007;16(10):1041–50.CrossRefPubMed
17.
18.
Dong H, Gbangou A, De Allegri M, Pokhrel S & Sauerborn R. The differences in characteristics between health-care users and non-users: implication for introducing community-based health insurance in Burkina Faso. European Journal of Health Economics, 2008; 9(1): 41–50.
19.
Gius MP. An analysis of the health insurance coverage of young adults. Int J Appl Econ. 2010;7(1):1–17.
20.
Sarpong N, Loag W, Fobil J, Meyer CG, Adu-Sarkodie Y, May J, et al. National health insurance coverage and socio-economic status in a rural district of Ghana. Trop Med Int Health. 2010;15(2):191–7.CrossRefPubMed
21.
Dixon J, Tenkorang EY, Luginaah I. Ghana’s national health insurance scheme: helping the poor or leaving them behind? Environment and Planning C: Politics and Space. 2011;29(6):1102–15.CrossRef
22.
Grossman M. On the concept of health capital and the demand for health. J Polit Econ. 1972;80:223–55.CrossRef
23.
Mwaura JW, Pongpanich S. Access to health care: the role of community based health insurance in Kenya. Pan African Medical Journal. 2012;12:35.PubMedPubMedCentral
24.
Bhat R, Jain N. Factors affecting the demand for health insurance in a micro insurance scheme. Indian Institute of Management, Working Paper 07-02. Ahmedabad: Research and Publication Department; 2006.
25.
Kronick R, Gilmer T. Explaining the decline in health insurance coverage, 1979 – 1995. Health Aff. 1999;18(2):30–47.CrossRef
26.
Savage E, Wright D. Health Insurance and health care utilization: theory and evidence from Australia 1989–1990. CHERE Discussion Paper 44. Sydney: University of Technology; 2001.
27.
Ayitey AM, Nketiah-Amponsah E, Barimah A. Determinants of insurance enrolment among Ghanaian adults: the case of the national health insurance scheme. Economics Management and Financial Markets. 2013;8(3):37.
28.
29.
Bourne PA, Kerr-Campbell MD. Determinants of self-rated private health insurance coverage in Jamaica. Health. 2010;2(06):541.CrossRef
30.
31.
Butler J. Estimating elasticity of demand for private health insurance in Australia. National center for epidemiology and population health. Canberra: ANU; 1999.
32.
Jutting J. Health Insurance for the Rural Poor? Community financing scheme in Senegal to protect against illness. Development and Cooperation. 2001;6:4–5. 4
33.
Cameron AC, McCallum. Private health insurance choices in Australia: The role of long-term utilization of health services, in Economics and health, 1995. Sydney: School of Health Services Management, UNSW; 1996. p. 143–157.
34.
Cameron AC, Trivedi PK. The role of income and health risk in the choice of health insurance: evidence from Ghana. J Public Econ. 1991;45(1):1–28.CrossRef
35.
Kirigia JM, Sambo LG, Nganda B, Mwabu GM, Chatora R, Mwase T. Determinants of health insurance ownership among south African women. BMC Health Serv Res. 2005;5:17.CrossRefPubMedPubMedCentral
36.
Nketiah-Amponsah E. Demand for health insurance among women in Ghana: cross-sectional evidence. International Research Journal of Finance and Economics. 2009;33:179–91.
37.
Duncan RP, Seccombe K, Amey C. Changes in health insurance coverage within rural and urban environments. J Rural Health. 1995;11:160–76.
38.
Stock R. Distance and utilization of health facilities in rural Nigeria. Soc Sci Med. 1983;17:63–570.CrossRef
39.
Jong KE, Smith DP, Yu XQ, O’Connell L, Goldstein D, Armstrong BK. Remoteness of residence and survival from cancer in new South Wales. Med J Aust. 2004;180:618–22.PubMed
40.
Criel B, Van der Stuyft P, Van Lerberghe W. The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns. Soc Sci Med. 1999;48:897–911.CrossRefPubMed
41.
Nemet GF, Bailey AJ. Distance and healthcare utilization among the rural elderly. Soc Sci Med. 2000;50:1197–208.CrossRefPubMed
42.
Frenzen PD. Health insurance coverage in U.S. urban and rural areas. J Rural Health. 1993;9:204–14.CrossRefPubMed
43.
Taylor AK, Cohen JW, Machlin SR. Being uninsured in 1996 compared to 1987: how has the experience of the uninsured changed over time? Health Serv Res. 2001;36:16–31.PubMedPubMedCentral
44.
Jehu-Appiah C, Aryeetey G, Spaan E, De Hoop T, Agyepong I, Baltussen R. Equity aspects of the national health insurance scheme in Ghana: who is enrolling, who is not and why? Soc Sci Med. 2011;72:157–65.CrossRefPubMed
45.
Coburn AF, Mcbridge TD, Ziller EC. Patterns of health insurance coverage among rural and urban children. Med Care Res Rev. 2002;59:272–92.CrossRefPubMed
46.
47.
Hu HM, Duncan RP, Radcliff TA, Porter CK, Hall AG. Variations in health insurance coverage for rural and urban nonelderly adult residents of Florida, Indiana, and Kansas. J Rural Health. 2006;22:147–50.CrossRefPubMed
48.
Comer J, Mueller K. Access to health care: urban-rural comparisons from a Midwestern agricultural state. J Rural Health. 1995;11:128–36.CrossRefPubMed
49.
Ketsche P. Employment-based health insurance: analysis of rural-urban differences in one state. Med Care Res Rev. 2005;62:458–78.CrossRefPubMed
50.
Fowler R, Noyahr L, Thornton J, Pinto R, Kahn J. An official thoracic society systematic review: the association between health insurance status and access, care delivery and outcomes for patients who are critically ill. American Journal of Critical Care Medicine. 2010;181:1003–11.CrossRef
51.
Von Neumann J, Morgenstern O. Theory of games and economic behaviour. Princeton, New Jersey, USA: Princeton University Press; 1994.
52.
53.
Schneider P. Why should the poor insure? Theories of decision-making in the context of health insurance. Health Policy Plan. 2004;19(6):347–55.CrossRef
54.
55.
Arrow K. Uncertainty and the welfare economics of medical care. Am Econ Rev. 1963;53(5):941–73.
56.
Feldstein MS. The welfare loss of excess health insurance. J Polit Econ. 1973;81(2, part 1):251–80.CrossRef
Metadata
Title
Differences in the determinants of health insurance enrolment among working-age adults in two regions in Ghana
Author
Stephen Kwasi Opoku Duku
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3192-9

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Practical utility of general practice data capture and spatial analysis for understanding COPD and asthma

Research article

Development and validation of a questionnaire to evaluate the factors influencing training transfer among nursing professionals

Research article

Challenges and opportunities for healthcare workers in a rural district of Chad

Research article

Job satisfaction among physiotherapists in Saudi Arabia: does the leadership style matter?

Research article

The status of ethics in Swedish health care management: a qualitative study

Research article

Patients’ perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals