Impact of National Health Insurance Scheme Status on Catastrophic Health Expenditure among Households in Ghana

Abstract

Background: Ghana’s pro-poor National Health Insurance Scheme (NHIS) has been implemented since 2004 to provide financial protection to households through the reduction of financial obstacles to accessing health care services therefore averting payment at point of use of health services. Using secondary data from the Ghana Living Standards Survey Round 6 (GLSS6). Objectives: The study sought to determine the proportion of households faced with catastrophe due to health care payments, impact of NHIS on out-of-pocket payment and the impact of NHIS on catastrophic health payments. Methods: To estimate proportion of households incurring catastrophic health expenditure, frequency, percent frequency and confidence intervals of point estimates were used. Chi-square test of independence and t-test were used to determine the relationship between variables and NHIS status. Multiple regression analysis coupled with propensity score matching with nearest neighbor (1 and 2) procedures was used to determine the impact of NHIS on OOP and CHE. Data analysis was done using Stata SE version 15 (StataCorp, Texas USA) and p<0.05 considered statistically significant. Results: The study found the proportion of households faced with catastrophic health expenditure to be 6.20% and 0.34% estimating health expenditure to be >= 10% and 40% of non-food expenditure respectively. Age, sex, place of residence, marital status, education, wealth quintile and size of household were found to be associated with NHIS status. The regression analysis showed statistically significant relationship between NHIS and CHE at 10% threshold. Using propensity score matching impact estimate technique, also showed statistically significant impact of NHIS on CHE at 10% threshold. Conclusion: The study therefore recommends further research to ascertain the quality of services provided under the NHIS and the reasons for making OOP especially amongst the marginalized. Keywords: out-of-pocket payment, catastrophic health expenditure, non-food expenditure and NHIS.