Abstract:
Social Health Insurance Schemes (SHIs) as Social Health Protection (SHP) interventions are an important tool for reducing poverty and ill health. For these reasons, governments employed SHI as a policy framework to promote access to healthcare, and to ensure financial protection among the poorest households to improve their health conditions. However, there is limited empirical studies on what motivates the poorest to get enrolled onto NHIS and how it helps them save income for consumption and other health outcomes. The study was conducted by engaging the Livelihood Empowerment Against Poverty (LEAP) household heads to identify the empirical evidence. The study also compared the consumption between insured and uninsured, and analysed the effects of NHIS membership on healthcare use and out-of-pocket health expenditure (OOPHE) among the poorest households. Decision making theories (Expected Utility Theory (EUT) and State Dependent Utility Theory (SDUT) and a Health behaviour theory (Health Belief Model (HBM)) were used as the theoretical lens for the study. The researcher adopted a pragmatic approach which involved the use of a mixed methodology, using both qualitative and quantitative approaches. A cross-sectional design was also adopted for the study. Entirely, the study was conducted in two districts; Shai Osudoku district in the Greater Accra Region and Amansie West district in the Ashanti Region and engaged LEAP beneficiary households
Thematic analysis approach was used to reveal the result of NHIS enrolment decision. In the analyses, the theoretical constructs of HBM proved useful in uncovering factors that influence enrolment decisions among poorest households. The study also found illness vulnerability and guaranteed financial access to healthcare as dominant factors that generally influenced household heads decisions to enrol onto NHIS. Addressing possible selection bias due to the non-random enrolment to the NHIS, the propensity score matching (PSM) technique was used to estimate the difference in outcomes between treated and control groups. The results of the average treatment effects on the treated reveals that participation in NHIS tends to increase in consumption expenditure by GH₵ 263.43, hospital visits by 0.74 visits and reduce OOPHE statistically significant by GH₵ 79.77 with household members that are insured than households’ members that are uninsured. By employing a mixed method approach instead of a quantitative approach alone, the study has contributed to existing knowledge by revealing a unique perspective on effects of NHIS on enrolment decisions among poorest households in Ghana. These positive outcomes of the study point to future research options.
