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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2020

Open Access 01-12-2020 | Research

Towards universal access to healthcare for older adults: an assessment of the old-age exemption policy under Ghana’s National Health Insurance Scheme

Authors: Fidelia A. A. Dake, Nele van der Wielen

Published in: International Journal for Equity in Health | Issue 1/2020

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Abstract

Background

Despite calls for governments to provide universal health coverage for all, social health insurance programmes (SHI) that specifically target older adults continue to be largely absent in many African countries. Only a few African countries have implemented SHI programmes that include specific provisions for older adults. Ghana’s National Health Insurance Scheme (NHIS) is one of the few programmes in Africa that exempts older adults from paying premiums for health insurance. This study examined socio-demographic factors associated with old-age premium exemption under Ghana’s NHIS.

Methods

The study used data from the seventh round of the Ghana Living Standards Survey (GLSS 7) conducted in 2017. Descriptive statistics and binary logistic regression were used in analysing data from a sample of 1532 older adults aged 70 years and older.

Results

The results reveal that only about 43% of older adults who were enrolled on the NHIS at the time of the survey acquired their membership through the old-age exemption policy. Additionally, increasing age was associated with higher odds of reporting exemption from paying premiums for health insurance. Also, older adults who are living in rural areas were more likely to pay premiums rather than being exempt as compared to their counterparts living in urban areas.

Conclusions

These findings indicate that the old-age exemption policy is not achieving the intended goal of providing financial risk protection for some older adults. Additionally, the policy is not reaching those who need it most, particularly those living in rural areas. Specific targeting is required for older adults living in rural areas who are less likely to benefit from the old-age exemption policy in spite of being eligible.
Literature
1.
UN-DESA. World population ageing 2017. World Popul Ageing. 2017;2017:1–124.
2.
3.
Beard JR, Officer A, De Carvalho IA, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387:2145–54.CrossRef
4.
Waterhouse P, Van Der Wielen N, Banda PC, Channon AA. The impact of multi-morbidity on disability among older adults in South Africa: do hypertension and socio-demographic characteristics matter? Int J Equity Health. 2017;16:1–10.CrossRef
5.
Lloyd-Sherlock P, Agrawal S. Pensions and the health of older people in South Africa: is there an effect? J Dev Stud. 2012;50:1570–86.CrossRef
6.
Lloyd-Sherlock P, Minicuci N, Beard J, Chatterji S. Social protection and preventing illness in developing countries: establishing the health effects of pensions and health insurance. Int Soc Secur Rev. 2012;65:51–68.CrossRef
7.
Parmar D, Williams G, Dkhimi F, Ndiaye A, Asante FA, Arhinful DK, Mladovsky P. Enrolment of older people in social health protection programs in West Africa - does social exclusion play a part? Soc Sci Med. 2014;119:36–44.CrossRef
8.
9.
10.
Fenny AP, Asante FA, Enemark U, Hansen KS. Treatment-seeking behaviour and social health Insurance in Africa: the case of Ghana under the National Health Insurance Scheme. Glob J Health Sci. 2014;7:296–314.CrossRef
11.
12.
Alfers L. The Ghana National Health Insurance Scheme : Barriers to Access for Informal The Ghana National Health Insurance Scheme : Barriers to Access for Informal Workers Laura Alfers; 2013. p. 17.
13.
Kusi A, Enemark U, Hansen KS, Asante FA. Refusal to enrol in Ghana’s National Health Insurance Scheme: is affordability the problem? Int J Equity Health. 2015;14:1–14.CrossRef
14.
Kotoh AM, Aryeetey GC, Van der Geest S. Factors that influence enrolment and retention in Ghana’ National Health Insurance Scheme. Int J Heal Policy Manag. 2017;7:443–54.CrossRef
15.
NHIA (2013) National Health Insurance Authority: 2013 annual report.
16.
Dixon J, Tenkorang EY, Luginaah I. Ghana’s National Health Insurance Scheme: helping the poor or leaving them behind? Environ Plan C Gov Policy. 2011;29:1102–15.CrossRef
17.
Kotoh AM, Van Der Geest S. Why are the poor less covered in Ghana’s national health insurance? A critical analysis of policy and practice. Int J Equity Health. 2016;15:1–11.CrossRef
18.
Van Der Wielen N, Channon AA, Falkingham J. Universal health coverage in the context of population ageing: what determines health insurance enrolment in rural Ghana? BMC Public Health. 2018;18:1–13.CrossRef
19.
Ghana Statistical Service (2019) Ghana Living Standards Survey (GLSS) 7 Main Report.
20.
Ghana Statistical Service (GSS). Ghana living standard survey round 6 (GLSS 6). Ghana Stat Serv. 2014:1–223.
21.
Andersen RM. Revisiting the behavioral model and access to medical care : does it matter ? J Health Soc Behav. 2020;36:1–10.CrossRef
22.
Li YN, Nong DX, Wei B, Feng QM, Luo HY. The impact of predisposing, enabling, and need factors in utilization of health services among rural residents in Guangxi, China. BMC Health Serv Res. 2016;16:1–9.
23.
Tesfaye G, Chojenta C, Smith R, Loxton D. Application of the Andersen-Newman model of health care utilization to understand antenatal care use in Kersa District, eastern Ethiopia. PLoS One. 2018;13:1–20.
24.
Hirshfield S, Downing MJ, Horvath KJ, Swartz JA, Chiasson MA. Adapting Andersen’s behavioral model of health service use to examine risk factors for hypertension among U.S. MSM. Am J Mens Health. 2018;12:788–97.CrossRef
25.
Chomi EN, Mujinja PG, Enemark U, Hansen K, Kiwara AD. Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter? Int J Equity Health. 2014;13:1–11.CrossRef
26.
Yang M, Barner J. Use of the Andersen health care services utilization behavioral model to understand the relationship between health insurance coverage and health care services utilization among the elderly. Value Heal. 2001;4:172.CrossRef
27.
Van Der Wielen N, Falkingham J, Channon AA. Determinants of National Health Insurance enrolment in Ghana across the life course: are the results consistent between surveys? Int J Equity Health. 2018;17:1–14.CrossRef
28.
Garshong B, Ansah E, Dakpallah G, Huijts I, Adjei S. A study on factors affecting the implementation of the exemption policy in Ghana. Bull Heal Inf. 2002;1:22–31.
29.
Dixon J. Determinants of health insurance enrolment in Ghana’s upper determinants of health insurance enrolment in Ghana’s upper west region west region; 2014.
30.
Kuuire VZ, Tenkorang EY, Rishworth A, Luginaah I, Yawson AE. Is the pro-poor premium exemption policy of Ghana’s NHIS reducing disparities among the elderly? Popul Res Policy Rev. 2017;36:231–49.CrossRef
31.
World Health Organization. World report on ageing and health. Geneva: World Health Organization; 2015.
32.
Van Der Wielen N, Channon AA, Falkingham J. Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the national health insurance scheme in Ghana. BMJ Glob Heal. 2018;3:1–9.
Metadata
Title
Towards universal access to healthcare for older adults: an assessment of the old-age exemption policy under Ghana’s National Health Insurance Scheme
Authors
Fidelia A. A. Dake
Nele van der Wielen
Publication date
01-12-2020
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-020-1156-2

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