Perception of quality of health delivery and health insurance subscription in Ghana

Abstract

BackgroundNational health insurance schemes (NHIS) in developing countries and perhaps in developed countries as well is a considered a pro-poor intervention by helping to bridge the financial burden of access to quality health care. Perceptions of quality of health service could have immense impacts on enrolment. This paper shows how perception of service quality under Ghana’s insurance programme contributes to health insurance subscription.MethodsThe study used the 2014 Ghana Demographic and Health Survey (GDHS) dataset. Both descriptive proportions and binary logistic regression techniques were applied to generate results that informed the discussion.ResultsOur results show that a high proportion of females (33 %) and males (35 %) felt that the quality of health provided to holders of the NHIS card was worse. As a result, approximately 30 % of females and 22%who perceived health care as worse by holding an insurance card did not own an insurance policy. While perceptions of differences in quality among females were significantly different (AOR = 0.453 [95 % CI = 0.375, 0.555], among males, the differences in perceptions of quality of health services under the NHIS were independent in the multivariable analysis. Beyond perceptions of quality, being resident in the Upper West region was an important predictor of health insurance ownership for both males and females.ConclusionFor such a social and pro-poor intervention, investing in quality of services to subscribers, especially women who experience enormous health risks in the reproductive period can offer important gains to sustaining the scheme as well as offering affordable health services.

Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review

“…Two (15.4%) studies each reported evidence from Burkina Faso and Tanzania, and one (7.7%) each reported from Niger, Sierra Leone, and Nigeria. Eight out of the 13 included studies were conducted in health facility-based settings [4,5,17,[50][51][52][53][54], two in a household-based based setting [11,55], two in community-based settings [56,57], and one was a national survey [58]. The majority (38%) of the included articles were cross-sectional studies [5,17,51,54,56], whilst the minority (8%) was quasi-experimental study design [52] (Fig.…”

“…2). Twelve of the included articles reported evidence on clients' perspective of the quality of maternal healthcare based on free maternal healthcare financing policies [4,5,11,17,[50][51][52][53][54][55][56]58] and one study based on partially free maternal healthcare financing policy [57].…”

“…Of the 13 included studies, 12 underwent methodological quality assessment using the 2018 MMAT [4,5,11,17,[50][51][52][53][55][56][57][58]. All the studies scored between 57.4 and 100%.…”

“…All the studies scored between 57.4 and 100%. The majority (33.3%) of the studies scored 71.4% [11,51,52,56] whilst 2 (16.7%) scored the least 57.1% [5,17]. Figure 3 presents the quality appraisal score per study.…”

“…Of the 13 included studies, only five (38.5%) reported evidence of high quality maternal healthcare based on pregnant women's perspective [5,11,[52][53][54]. However, in 8 of the studies, pregnant women were not satisfied with the quality of maternal healthcare rendered under the free maternal care policy [4,17,50,51,[55][56][57][58]. Table 2 presents a summary of the study findings from all the 13 included studies.…”