Equitable access to health insurance for socially excluded children. The case of the National Health Insurance Scheme (NHIS) in Ghana
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
To help reduce child mortality and reach universal health coverage, Ghana extended free membership of
the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the
introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few
studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant
financial barriers to membership. In this paper we therefore look beyond economic explanations
of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In
particular, we investigate whether social exclusion, as measured through a sociocultural, political and
economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional
survey of 4050 representative households conducted in Ghana in 2012. Household indices were created
to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to
study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally,
economically and politically excluded children are less likely to enrol in the NHIS.
Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partiallyenrolled
(i.e. not all children enrolled within the household) than fully-enrolled. These results suggest
that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to
improve coverage by removing the remaining small, annually renewable registration fee, implementing
and publicising the new clause that de-links premium waivers from parental membership, establishing
additional scheme administrative offices in remote areas, holding regular registration sessions in schools
and conducting outreach sessions and providing registration support to female guardians of children.
Ensuring equitable access to NHIS will contribute substantially to improving child health and reducing
child mortality in Ghana.
Description
Keywords
Universal health coverage, National Health Insurance Scheme, Social exclusion, Ghana, Children, Enrolment