Does the National Health Insurance Scheme provide financial protection to households in Ghana?
Identifieur interne : 000366 ( Main/Exploration ); précédent : 000365; suivant : 000367Does the National Health Insurance Scheme provide financial protection to households in Ghana?
Auteurs : Anthony Kusi [Danemark, Ghana] ; Kristian Schultz Hansen [Royaume-Uni] ; Felix A. Asante [Ghana] ; Ulrika Enemark [Danemark]Source :
- BMC Health Services Research [ 1472-6963 ] ; 2015.
Abstract
Excessive healthcare payments can impede access to health services and also disrupt the welfare of households with no financial protection. Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures.
Data was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis.
About 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the insured and their households.
The NHIS has significant effect in reducing OOPHE and offers financial protection against CHE for insured individuals and their households though they still made some out-of-pocket payments. Efforts should aim at eliminating OOPHE for the insured if the objective for establishing the NHIS is to be achieved.
Url:
DOI: 10.1186/s12913-015-0996-8
PubMed: 26275412
PubMed Central: 4537562
Affiliations:
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Box LG 74, Legon, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Legon, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Hansen, Kristian Schultz" sort="Hansen, Kristian Schultz" uniqKey="Hansen K" first="Kristian Schultz" last="Hansen">Kristian Schultz Hansen</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London</wicri:regionArea><wicri:noRegion>WC1H 9SH London</wicri:noRegion></affiliation></author><author><name sortKey="Asante, Felix A" sort="Asante, Felix A" uniqKey="Asante F" first="Felix A" last="Asante">Felix A. Asante</name><affiliation wicri:level="4"><nlm:aff id="Aff3">Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Legon, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. 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Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures.</p></sec><sec><title>Methods</title><p>Data was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis.</p></sec><sec><title>Results</title><p>About 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the insured and their households.</p></sec><sec><title>Conclusion</title><p>The NHIS has significant effect in reducing OOPHE and offers financial protection against CHE for insured individuals and their households though they still made some out-of-pocket payments. Efforts should aim at eliminating OOPHE for the insured if the objective for establishing the NHIS is to be achieved.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mcintyre, D" uniqKey="Mcintyre D">D McIntyre</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Baeza, Cc" uniqKey="Baeza C">CC Baeza</name></author><author><name sortKey="Packard, Tg" uniqKey="Packard T">TG Packard</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Escobar, Ml" uniqKey="Escobar M">ML Escobar</name></author><author><name sortKey="Griffin, Cc" uniqKey="Griffin C">CC Griffin</name></author><author><name sortKey="Shaw, Rp" uniqKey="Shaw R">RP Shaw</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ekman, B" uniqKey="Ekman B">B 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first="Anthony" last="Kusi">Anthony Kusi</name></noRegion><name sortKey="Enemark, Ulrika" sort="Enemark, Ulrika" uniqKey="Enemark U" first="Ulrika" last="Enemark">Ulrika Enemark</name></country><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Kusi, Anthony" sort="Kusi, Anthony" uniqKey="Kusi A" first="Anthony" last="Kusi">Anthony Kusi</name></region><name sortKey="Asante, Felix A" sort="Asante, Felix A" uniqKey="Asante F" first="Felix A" last="Asante">Felix A. Asante</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Hansen, Kristian Schultz" sort="Hansen, Kristian Schultz" uniqKey="Hansen K" first="Kristian Schultz" last="Hansen">Kristian Schultz Hansen</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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