Exploring heterogeneity of national health insurance scheme enrolment among persons in the informal sector

Abstract

The Ghanaian government began implementing the National Health Insurance Scheme (NHIS) in 2005, anchored on the universal health coverage principle. However, informal sector workers contribute to the low enrolment into the scheme. This paper examines the factors that influence enrolment status in Ghana's NHIS among individuals in the informal sector. The study employed the fixed-effects logit model, using the Ghana Socioeconomic Panel Survey datasets. The findings revealed that gender, age, education, marital status, household size, physical activity, income, savings and subjective social welfare determine enrolment decisions of persons in the informal sector. Drivers of NHIS enrolment for male and female household heads were secondary education and household size. Heterogeneously, age, Junior High School education, married, physical activity, subjective social welfare and savings influenced only male-headed households' enrolment status. The study shows differences in enrolment status among rural and urban residents, as age, education, marital status, household size, and physical activity influenced rural residents, while for urban inhabitants', savings determined their NHIS enrolment decisions. However, gender, obesity, income and subjective social welfare predicted enrolment decisions for rural and urban residents. Finally, two variables, gender (male) and physical activity predicted the NHIS enrolment decision among the poor, whereas subjective social welfare and savings influenced the wealthiest enrolment decisions.

Effect of social capital on enrolment of informal sector occupational groups in the national health insurance scheme in Ghana: a cross-sectional survey

“…Understandably, persons with basic level of education; the males; minority ethnic groups and persons who use pharmacy as their usual source of healthcare are less likely to enrol and stay active in the NHIS. These findings largely corroborate other studies conducted in Ghana [41,53,59,62,63] and elsewhere [4,5].…”

Income and health insurance effects on modern health-seeking behaviours in rural Ghana: nature and extent of bias involved

“…These results suggest that rural residents suffering from fever, cold/cough, or diarrhoea exhibit a higher probability of visiting a modern healthcare facility compared to other illnesses. This result is consistent with the findings of Sekyi and Domanban (2012) in Ghana.…”

Heterogeneous effects of national health insurance scheme on healthcare utilisation: evidence from Ghana

“…The estimated marginal effects suggest that individuals who suffer from either fever, cold/cough or diarrhoea were 24.1%, 19.3 and 26.7%, respectively, more likely to visit a health facility relative to other illnesses. This result is in line with the work of Sekyi and Domanban (2012). However, in a study in Zambia, Masiye and Kaonga (2016) found that having a headache, diarrhoea, or “other disease” was related to a lower likelihood of seeking formal treatment than reporting malaria or fever.…”