NATIONAL HEALTH INSURANCE IN GHANA
Many low-income and middle-income countries are increasingly implementing prepayment schemes to provide financial risk protection and equitable access to health care services for their populations, particularly the poor. Ghana had a free health care system after independence in the 1950s, financed by general taxation. However, this system of health care changed when the economy started declining and user fees were partially introduced in the 1970s and 1980s to offset costs of health care services delivery. The system created inequity in access to health care and in some cases led to avoidable deaths. As a result, the National Health Insurance Scheme (NHIS) was created in 2003 to replace out-of-pocket expenditures and ensure equity in health care access. The NHIS is managed by the National Health Insurance Authority, a body mandated by law to regulate both public and private health insurance schemes in the country.
Our study aimed to examine equity in enrolment in the Ghana National Health Insurance Scheme (NHIS) to inform policy decisions regarding attainment of universal health coverage. In the first study to use data from the Ghana Living Standards Survey to examine equity in enrolment in the NHIS, we found inequity in enrolment and significant associations between socio-demographic factors and NHIS enrolment. While enrolment was concentrated among poor households especially those headed by males, the likelihood of NHIS enrolment increased from poorer to richest quintiles and from low to high levels of education. Policy-makers need to ensure equity as they strive to achieve universal health coverage.
