Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage

Abstract

The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?

“…Summary of peer reviewed articles on the NHIS sustainability challenges and prospects are presented in Table 2. Other perspectives on threats to the sustainability of the NHIS centered on equity in premium payment [38,40,41], alternate payment mechanisms [42], perceived and measured effect of health insurance on health outcomes [8,9,43]. …”

The Effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilization

“…The low enrollment among the poor is likely to not only relate to lower economic well-being but also to considerable travel time to health facilities. Other authors suggest that fees could be too high for the poor [24], awareness about insurance low, or the perceived value for money insufficient [25,26]. In other words, for those who did not sign up, their perceived net benefits were negative, either because expected costs were too high or benefits were too low.…”

Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps, and social equity considerations

“…Finally, this study did not assess horizontal equity. As noted above, horizontal equity can refer to people with the same ability to pay making the same contribution (Amporfu, ). This type of assessment was not undertaken, as this study focuses on a non‐contributory scheme.…”

“…Equity in health care financing can be characterized as vertical (financial contribution proportional to capacity to pay) and horizontal (those with the same capacity to pay making the same contribution) (Wagstaff and van Doorslaer, ; Murray et al, ; O’Donnell et al, ). Vertical equity focuses on progressivity whereby health care contributions, as a proportion of income, rise as income increases (Amporfu, ). Vertical equity can be assessed by the degree of inequality in paying for health care when considering individuals’ unequal ability to pay (O’Donnell et al, ; Van Doorslaer, Wagstaff and Rutten, 1993).…”