Abstract:
In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) to move towards Universal
Health Coverage. NHIS enrolment is mandatory for all Ghanaians, but the most recent estimates
show that coverage stands under 40%. The evidence on the relationship between socio-economic
characteristics and NHIS enrolment is mixed, and comes mainly from studies conducted in a few
areas. Therefore, in this study we investigate the socio-economic determinants of NHIS enrolment
using three recent national household surveys. We used data from the Ghanaian Demographic and
Health Survey conducted in 2014, the Multiple Indicator Cluster Survey conducted in 2011 and the
sixth wave of the Ghana Living Standard Survey conducted in 2012–13. Given the multilevel nature
of the three databases, we use multilevel logistic regression models to estimate the probability of enrolment
for women and men separately. We used three levels of analysis: geographical clusters,
household and individual units. We found that education, wealth, marital status—and to some extent—
age were positively associated with enrolment. Furthermore, we found that enrolment was correlated
with the type of occupation. The analyses of three national household surveys highlight the
challenges of understanding the complex dynamics of factors contributing to low NHIS enrolment
rates. The results indicate that current policies aimed at identifying and subsidizing underprivileged
population groups might insufficiently encourage health insurance enrolment
