Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana

Williams, Gemma; Parmar, Divya; Dkhimi, Fahdi; Asante, Felix Ankomah; Arhinful, Daniel; Mladovsky, Philipa

doi:10.1016/j.socscimed.2017.05.023

Cited by 18 publications

(18 citation statements)

References 22 publications

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“…The results of the multivariate analysis found that wealth status is one of the determinants of health insurance ownership among pregnant women. This nding con rms the results of previous studies with the same research theme in Nigeria and Ghana which informed that those who have good wealth status are more likely to participate in health insurance 22,28,29 . Pregnant women with low wealth status probably do not have a xed source of income.…”

Section: Discussionsupporting

confidence: 87%

The Determinant of Health Insurance Ownership Among Pregnant Women in Indonesia

Laksono

Wulandari

Matahari

2020

Preprint

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Background: Health insurance is one indicator of the readiness of pregnant women for the delivery process. The study was aimed at analyzing the determinants of health insurance ownership among pregnant women in Indonesia.Methods: The study involved 2,542 pregnant women in Indonesia. The variables analyzed included type of place of residence, age group, education level, employment status, marital status, parity, wealth status, and know the danger signs of pregnancy. Determination of determinant by binary logistic regression.Results: The results show that pregnant women with higher education were 3.349 times more likely than no education pregnant women to have health insurance. Pregnant women with wealth status in the middle category were 0.679 times more likely than the poorest pregnant women to have health insurance. Meanwhile, the richest pregnant women had 1.358 times more chances than the poorest pregnant women to have health insurance. Grande multiparous pregnant women were 1.544 times more likely than primiparous pregnant women to have health insurance. Pregnant women who know the danger signs of pregnancy were 1.416 times more likely than pregnant women who don't know the danger signs of pregnancy. Conclusions: It concluded that 4 variables were proven as determinants of health insurance ownership in Indonesia. The four variables were education level, wealth status, parity, and know the danger signs of pregnancy.

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Section: Discussionsupporting

confidence: 87%

The Determinant of Health Insurance Ownership Among Pregnant Women in Indonesia

Laksono

Wulandari

Matahari

2020

Preprint

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“…Coordinated approaches to increasing enrollment among hard-to-reach populations, such as informal sector workers, alongside the private facilities that serve these populations, are needed in order to ensure that service availability—in the form of more accredited facilities—increases along with client enrollments. While literature has demonstrated that patient awareness campaigns and support are important to increase overall SHI uptake [ 43 , 44 ], our findings suggest that greater education and awareness among both providers and patients is important to ensuring the successful growth of emerging health insurance markets. Although the existing literature on private provider experiences with SHIs is very limited, these findings are in line with a study in Karnataka, India, which found that lack of coordinated rollout and alignment of incentives among providers (including private providers) and patients negatively impacted social health insurance implementation in the state [ 45 ].…”

Section: Discussionmentioning

confidence: 70%

Private healthcare provider experiences with social health insurance schemes: Findings from a qualitative study in Ghana and Kenya

2018

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BackgroundIncorporating private healthcare providers into social health insurance schemes is an important means towards achieving universal health coverage in low and middle income countries. However, little research has been conducted about why private providers choose to participate in social health insurance systems in such contexts, or their experiences with these systems. We explored private providers’ perceptions of and experiences with participation in two different social health insurance schemes in Sub-Saharan Africa—the National Health Insurance Scheme (NHIS) in Ghana and the National Hospital Insurance Fund (NHIF) in Kenya.MethodsIn-depth interviews were held with providers working at 79 facilities of varying sizes in three regions of Kenya (N = 52) and three regions of Ghana (N = 27). Most providers were members of a social franchise network. Interviews covered providers’ reasons for (non) enrollment in the health insurance system, their experiences with the accreditation process, and benefits and challenges with the system. Interviews were coded in Atlas.ti using an open coding approach and analyzed thematically.ResultsMost providers in Ghana were NHIS-accredited and perceived accreditation to be essential to their businesses, despite challenges they encountered due to long delays in claims reimbursement. In Kenya, fewer than half of providers were NHIF-accredited and several said that their clientele were not NHIF enrolled. Understanding of how the NHIF functioned was generally low. The lengthy and cumbersome accreditation process also emerged as a major barrier to providers’ participation in the NHIF in Kenya, but the NHIS accreditation process was not a major concern for providers in Ghana.ConclusionsIn expanding social health insurance, coordinated efforts are needed to increase coverage rates among underserved populations while also accrediting the private providers who serve those populations. Market pressure was a key force driving providers to gain and maintain accreditation in both countries. Developing mechanisms to engage private providers as stakeholders in social health insurance schemes is important to incentivizing their participation and addressing their concerns.

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“…In response to the call to provide affordable health care for all, most low-and-middle income countries including some countries in Africa, e.g. Ghana, Kenya and Rwanda have instituted one form of social health protection program [ 5 ] or the other including via health insurance [ 3 , 6 ] with the aim of achieving UHC [ 7 ]. Social health protection has been identified as a strategy for achieving universal access to healthcare by the International Labor Organisation who define social health protection as “a series of public or publicly organized and mandated private measures against social distress and economic loss caused by the reduction of productivity, stoppage or reduction of earnings or the cost of necessary treatment that can result from ill health” (ILO, 2008:3) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Examining equity in health insurance coverage: an analysis of Ghana’s National Health Insurance Scheme

Dake

2018

Int J Equity Health

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BackgroundFollowing years of out-of-pocket payment for healthcare, some countries in Africa including Ghana, Kenya and Rwanda have instituted social health protection programs through health insurance to provide access to quality and affordable healthcare especially for the poor. This paper examines equity in coverage under Ghana’s National Health Insurance Scheme (NHIS).MethodsSecondary data from the 2008 Ghana Demographic and Health Survey based on an analytical sample of 4821 females (15–49 years) and 4568 males (15–59 years) were analysed using descriptive, bivariate and multivariate methods. Concentration curves and indices were used to examine equity in coverage on the NHIS.ResultsAs at 2008, more than 60% of Ghanaians aged 15–59 years were not covered under the NHIS with slightly more females (38.9%) than males (29.7%) covered. Coverage was highest among the highly educated, professionals, those from households in the richest wealth quintile and urban residents. Lack of coverage was most concentrated among the poor.ConclusionsUniversal coverage under the NHIS is far from being achieved with marked exclusion of the poor. There is the need for deliberate action to enrol the poor under the NHIS.

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Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana

Cited by 18 publications

References 22 publications

The Determinant of Health Insurance Ownership Among Pregnant Women in Indonesia

The Determinant of Health Insurance Ownership Among Pregnant Women in Indonesia

Private healthcare provider experiences with social health insurance schemes: Findings from a qualitative study in Ghana and Kenya

Examining equity in health insurance coverage: an analysis of Ghana’s National Health Insurance Scheme

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