Social deterministic factors to participation in the National Health Insurance Scheme in the context of rural Ghanaian setting

Abstract

The primary purpose of this study is to identify predictors of complete household enrollment into the National Health Insurance Scheme (NHIS) among inhabitants of the Barekese sub-district in the Ashanti Region of Ghana. Heads of households in 20 communities from the Barekuma Collaborative Community Project site were interviewed to gather data on demographic, socioeconomic status (SES) indicators and complete household subscription in the NHIS. Logistic regression model was used to predict enrollment in the NHIS. Of the 3228 heads of households interviewed, 60 percent reported having all members of their respective households enrolled in the NHIS. Residents in the classified Middle and High SES brackets had 1.47 (95% CI: 1.21-1.77) and 1.66 (95% CI: 1.27-2.16) times higher odds, respectively, of complete household enrollment compared to their counterparts in the Low SES category. The odds of enrolling in the program tend to increase progressively with the highest level of education attained by the head of the family unit. Eight years after the introduction of the national health insurance policy in Ghana, the reported subscription rate for complete households was about 60 percent in the 20 rural communities that participated in the study. This finding calls for the need to step up further national strategies that will help increase enrollment coverage, especially among the poor and less educated in the rural communities.

Households Sociodemographic Profile as Predictors of Health Insurance Uptake and Service Utilization: A Cross-Sectional Study in a Municipality of Ghana

“…This number is about 2 times higher than the 2012 and 2013 national level active membership which stands at 37% and 38%, respectively. Again, the 74% insured clients were about 1.2 times higher than a similar study in Barekese district in the Ashanti Region of Ghana [28,32]. The high rate of active policy membership may help to reduce the burden associated with out-of-pocket payment for healthcare.…”

“…Also, the size of individual households predicts their NHIS policy ownership. The odds of enrolling and renewing NHIS policy decreases with household size [28,32]. In a previous study, individuals with a larger household size, for instance, 12 and above (AOR = 0.33; 95% CI; 0.24, 0.45) were less likely to enrol in the NHIS scheme [32].…”

“…The odds of enrolling and renewing NHIS policy decreases with household size [28,32]. In a previous study, individuals with a larger household size, for instance, 12 and above (AOR = 0.33; 95% CI; 0.24, 0.45) were less likely to enrol in the NHIS scheme [32]. The burden of enrolling and renewing the NHIS policy could be challenging for individuals with a higher household size.…”

“…These factors are mostly related to the social, economic, demographic, and health status of households [27][28][29][30][31][32][33][34][35][36]. Across different regional and geographic boundaries, social factor such as gender influences NHIS policy enrolment [27,28,30,32,34]. Past studies, for instance, have showed that females have more propensities to enrol and renew their NHIS policy compared with males [30,31,33].…”

“…Among different age groups, previous evidence showed that the elderly people of 60-70 years and above stand at greater odds of enrolling and renewing their NHIS policy. Across different studies, the elderly people of about 60-70 years and above are about 1.8-4.2 times (mean = 2.45) more likely to enrol and renew their NHIS policy compared with those below this age category [29][30][31][32][33]. In the Eastern and Central regions of Ghana, for instance, the odds of enrolment into the NHIS among people in the richest quintile increase with the age; those aged 70 years and above were 13.6 times more likely to have NHIS active membership compared with the younger population [29].…”