Exemption for the poor or the rich? An assessment of socioeconomic inequalities in Ghana's national health insurance exemption policies.

Out-of-pocket payments for health are considered a major limitation to universal health coverage (UHC). Policymakers across the globe are committed to achieving UHC through the removal of financial barriers to health care. In Ghana, a national health insurance scheme was established for this purpose. A unique feature of the scheme is its premium exemption policies for vulnerable groups. In this article, we access the nature of socioeconomic inequality in these exemption policies. We used data from the Ghana Living Standards Survey rounds six and seven. Socioeconomic inequality was assessed using concentration curves and indices. Real household annual total consumption expenditure adjusted by adult equivalence scale was used as a wealth indicator. Four categories of exemption were used as outcome variables. These were exemptions for indigents, individuals <18 years, the aged and free maternal service. The analysis was also disaggregated by rural and urban locations of individuals. We found that while overall national health insurance scheme (NHIS) coverage was concentrated among the wealthy, all categories of premium exemption were concentrated among the poor. There was also evidence of a general decline in the magnitude of inequality over the survey years. With the specific exemptions, inequalities in exemption for indigents and maternal services were most relevant in rural locations, while inequalities in exemption for individuals <18 years and the aged were significant in urban areas. The findings suggest that the exemption policies under the NHIS are generally progressive and achieve the objective of inclusion for the underprivileged. However, it also provides lessons for better targeting and effective implementation. There may be a need for separate efforts to better target individuals in rural and urban locations to improve enrolment.

Novignon J ，Atakorah YB ，Chijere Chirwa G 《-》

Towards universal access to healthcare for older adults: an assessment of the old-age exemption policy under Ghana's National Health Insurance Scheme.

Dake FAA ，van der Wielen N 《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》

Subscribers' perception of quality of services provided by Ghana's National Health Insurance Scheme - what are the correlates?

Nketiah-Amponsah E ，Alhassan RK ，Ampaw S ，Abuosi A ... -  《BMC HEALTH SERVICES RESEARCH》

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》