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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Research

Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme

Authors: Genevieve Cecilia Aryeetey, Judith Westeneng, Ernst Spaan, Caroline Jehu-Appiah, Irene Akua Agyepong, Rob Baltussen

Published in: International Journal for Equity in Health | Issue 1/2016

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Abstract

Background

Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty.

Methods

We conducted two repeated household surveys in two regions of Ghana in 2009 and 2011. We first analyzed the effect of OOPE on poverty by estimating poverty headcount before and after OOPE were incurred. We also employed probit models and use of instrumental variables to analyze the effect of health insurance on OOPE, CE and poverty.

Results

Our findings showed that between 7–18 % of insured households incurred CE as a result of OOPE whereas this was between 29–36 % for uninsured households. In addition, between 3–5 % of both insured and uninsured households fell into poverty due to OOPE. Our regression analyses revealed that health insurance enrolment reduced OOPE by 86 % and protected households against CE and poverty by 3.0 % and 7.5 % respectively.

Conclusion

This study provides evidence that high OOPE leads to CE and poverty in Ghana but enrolment into the NHIS reduces OOPE, provides financial protection against CE and reduces poverty. These findings support the pro-poor policy objective of Ghana’s National Health Insurance Scheme and holds relevance to other low and middle income countries implementing or aiming to implement insurance schemes.
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Metadata
Title
Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme
Authors
Genevieve Cecilia Aryeetey
Judith Westeneng
Ernst Spaan
Caroline Jehu-Appiah
Irene Akua Agyepong
Rob Baltussen
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0401-1

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