Inequalities in out-of-pocket health expenditure among women of reproductive age: after-effects of national health insurance scheme initiation in Ghana

Abstract

Background Improvement in maternal healthcare is a public health priority. Unfortunately, in spite of the efforts made over time regarding universal coverage, there remain issues with accessibility and use of healthcare services up to now. In this study, we examined inequalities in out-of-pocket health expenditure among women of reproductive age in Ghana. We analyzed secondary data collected in Ghana Demographic and Health Survey (GDHS) - 2014. A total of 9,002 women of reproductive age were included in this study. Lorenz curves and the concentration index were used to examine neighborhood socioeconomic disadvantage inequalities in out-of-pocket expenditure for maternal healthcare utilization Results About two thirds (66.0%) of women of reproductive age in Ghana were covered by health insurance. In sum, women of high neighborhood socioeconomic disadvantage status had the least out-of-pocket expenditure for total healthcare utilization, laboratory investigations, antenatal care visits, post-natal care visits, care for new born for up to 3 months, and other healthcare services. The converse was however true for family planning service utilization. Using Concentration Index, we quantified the degree of neighborhood socioeconomic disadvantage inequalities in healthcare service utilizations. Conclusion This study showed a gap in health insurance coverage among women of reproductive age. There were also inequalities in out-of-pocket expenditure for healthcare services utilization. It is expedient for stakeholders in the healthcare system to make policies targeted at bridging the neighborhood socioeconomic differences in maternal healthcare use and develop programs to improve women’s financial protection. Moreover, enlightenment on health insurance availability and coverage should focus on women at risk of out-of-pocket expenditure.

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

“…The overall findings showed positive results where the beneficiaries had over 50 percent access to key healthcare services at health facilities at the local level in Ghana. This finding concurs with some recent studies on pregnant women' increased access to maternal healthcare services under NHIS in Ghana (Ameyaw et al, 2021;Ekholuenetale and Barrow, 2021).…”

“…There are reasons for such a rate of population coverage of the NHIS, one of which is the access to quality healthcare services. The literature points out that the better the quality of healthcare services, the more the enrolment into NHIS as improving quality healthcare services will enhance the full benefits of the NHIS (Kipo-Sunyehzi, 2020; Ekholuenetale and Barrow, 2021).…”

“…The empirical evidence shows that about 78.2 percent of pregnant women indicated that NHIS is helping them in accessing maternal healthcare services in Ghana. Thus, the free maternal health policy has a positive effect on NHIS enrolment (Agbanyo, 2020;Okoroh et al, 2020;Umar et al, 2020;Ekholuenetale and Barrow, 2021). Despite this positive aspect of NHIS, other studies identified some challenges including distance travel to accredited health facilities, travel cost and perceived poor quality of healthcare services rendered to NHIS beneficiaries (Kodom et al, 2019;Ameyaw et al, 2021).…”

Out-of-Pocket Healthcare Payments and Impoverishment Among Migrant Adolescent Female Head Porters in Ghana: A Cross Sectional Study

“…This study revealed that among vulnerable populations such as migrants in the informal sector, the incidence of OOP payment for healthcare is very high (89.0%) relative to findings from other studies. Akazili et al, (2017) and Ekholuenetale and Barrow (2021) found that rich individuals or households were more likely to incur OOP payments. For example, in their study in Ghana, Akazili et al (2017) found that 10.9% of the population incur OOP payments, and concluded that richer households incurred more OOP relative to poorer ones.…”

“…For example, in their study in Ghana, Akazili et al (2017) found that 10.9% of the population incur OOP payments, and concluded that richer households incurred more OOP relative to poorer ones. Ekholuenetale and Barrow (2021) found that 17% of women from wealthy home paid OOP for health care.…”