Is enrolment in the national health insurance scheme in Ghana pro-poor? Evidence from the Ghana Living Standards Survey.

This article examines equity in enrolment in the Ghana National Health Insurance Scheme (NHIS) to inform policy decisions on progress towards realisation of universal health coverage (UHC). Secondary analysis of data from the sixth round of the Ghana Living Standards Survey (GLSS 6). Household based. A total of 16 774 household heads participated in the GLSS 6 which was conducted between 18 October 2012 and 17 October 2013. Equity in enrolment was assessed using concentration curves and bivariate and multivariate analyses to determine associated factors. Equity in NHIS enrolment. Survey participants had a mean age of 46 years and mean household size of four persons. About 71% of households interviewed had at least one person enrolled in the NHIS. Households in the poorest wealth quintile (73%) had enrolled significantly (p<0.001) more than those in the richest quintile (67%). The concentration curves further showed that enrolment was slightly disproportionally concentrated among poor households, particularly those headed by males. However, multivariate logistic analyses showed that the likelihood of NHIS enrolment increased from poorer to richest quintile, low to high level of education and young adults to older adults. Other factors including sex, household size, household setting and geographic region were significantly associated with enrolment. From 2012 to 2013, enrolment in the NHIS was higher among poor households, particularly male-headed households, although multivariate analyses demonstrated that the likelihood of NHIS enrolment increased from poorer to richest quintile and from low to high level of education. Policy-makers need to ensure equity within and across gender as they strive to achieve UHC.

Nsiah-Boateng E ，Prah Ruger J ，Nonvignon J 《BMJ Open》

Determinants of National Health Insurance enrolment in Ghana across the life course: Are the results consistent between surveys?

van der Wielen N ，Falkingham J ，Channon AA 《International Journal for Equity in Health》

Universal health coverage in the context of population ageing: What determines health insurance enrolment in rural Ghana?

Van der Wielen N ，Channon AA ，Falkingham J 《BMC PUBLIC HEALTH》

The state of enrollment on the National Health Insurance Scheme in rural Ghana after eight years of implementation.

Kwarteng A ，Akazili J ，Welaga P ，Dalinjong PA ，Asante KP ，Sarpong D ，Arthur S ，Bangha M ，Goudge J ，Sankoh O ... -  《International Journal for Equity in Health》

Determinants of health insurance enrolment in Ghana: evidence from three national household surveys.

In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) to move towards Universal Health Coverage. NHIS enrolment is mandatory for all Ghanaians, but the most recent estimates show that coverage stands under 40%. The evidence on the relationship between socio-economic characteristics and NHIS enrolment is mixed, and comes mainly from studies conducted in a few areas. Therefore, in this study we investigate the socio-economic determinants of NHIS enrolment using three recent national household surveys. We used data from the Ghanaian Demographic and Health Survey conducted in 2014, the Multiple Indicator Cluster Survey conducted in 2011 and the sixth wave of the Ghana Living Standard Survey conducted in 2012-13. Given the multilevel nature of the three databases, we use multilevel logistic regression models to estimate the probability of enrolment for women and men separately. We used three levels of analysis: geographical clusters, household and individual units. We found that education, wealth, marital status-and to some extent-age were positively associated with enrolment. Furthermore, we found that enrolment was correlated with the type of occupation. The analyses of three national household surveys highlight the challenges of understanding the complex dynamics of factors contributing to low NHIS enrolment rates. The results indicate that current policies aimed at identifying and subsidizing underprivileged population groups might insufficiently encourage health insurance enrolment.

Salari P ，Akweongo P ，Aikins M ，Tediosi F ... -  《-》