Abstract:
Objectives 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).
Design Secondary analysis of data from the sixth round of
the Ghana Living Standards Survey (GLSS 6).
Setting Household based.
Participants A total of 16 774 household heads
participated in the GLSS 6 which was conducted between
18 October 2012 and 17 October 2013.
Analysis Equity in enrolment was assessed using
concentration curves and bivariate and multivariate
analyses to determine associated factors.
Main outcome measure Equity in NHIS enrolment.
Results 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.
Conclusions 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.
