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Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana.
- Source :
-
Health policy and planning [Health Policy Plan] 2019 Nov 01; Vol. 34 (9), pp. 694-705. - Publication Year :
- 2019
-
Abstract
- A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012-13 Ghana Living Standards Survey (nā=ā72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (-5 p.p. vs -9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (-10 p.p. vs. -6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC.<br /> (© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)
- Subjects :
- Cross-Sectional Studies
Ghana
Humans
Medically Uninsured statistics & numerical data
Poverty statistics & numerical data
Socioeconomic Factors
Time Factors
Travel statistics & numerical data
Vulnerable Populations
Financing, Personal statistics & numerical data
Health Services Accessibility statistics & numerical data
National Health Programs statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2237
- Volume :
- 34
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Health policy and planning
- Publication Type :
- Academic Journal
- Accession number :
- 31539034
- Full Text :
- https://doi.org/10.1093/heapol/czz093