Assessment of Ghana’s National Health Insurance Scheme (NHIS) Enrolment on Healthcare Utilization Among Renal Patients at The Korle Bu Teaching Hospital

Abstract

Background: Renal disease presents a significant public health challenge, with patients requiring frequent and specialized medical care. In many countries, including Ghana, the National Health Insurance Scheme (NHIS) has been introduced to mitigate healthcare costs and improve access to necessary services. NHIS enrolment is particularly crucial for renal patients, given the financial burden of treatments such as dialysis and transplants. However, the extent to which NHIS enrolment influences healthcare utilization among renal patients remains underexplored. Objectives: The study intended to investigate the NHIS enrolment on healthcare utilization among renal patients in Korle-Bu Teaching Hospital. Methods: The study adopted a quantitative research approach and cross-sectional design in which consecutive sampling technique was used to select 200 from the population of 400 for the study. A structured questionnaire was used as a data collection tool. The study tested the association between enabling, need and predisposing factors and utilization of renal service using Chi-square. Additionally, multivariate regression was employed to assess the NHIS enrolment, enabling, need and predisposing factors influencing utilization of renal service. Results: The study found that the majority of renal patients (93.5%) were currently enrolled in the National Health Insurance Scheme (NHIS). Among those not enrolled, reasons included expired insurance (30.8%), perceived ineffectiveness of NHIS in covering medical expenses (30.8%), and personal choice (38.4%). For the predisposing factor, patients who were aged 26-35 years were approximately 21 times more likely to utilise services (P<0.001). In terms of enabling and need factors, individuals who had the ability to perform daily activities were 1.8 times more likely to utilize renal services (p=0.008). Patients who were able to balance lifestyle were 1.84 more likely to utilize services (p=0.016). Patients who were assured about the availability of specialists were 2.4 times more likely to visit the renal unit (p=0.030). Individuals who agreed that NHIS plan partially covers renal services show a significant 1.12 times more likelihood of utilization of the facility (p=0.022). It was found that, very long waiting time with NHIS resulted in 98% less likelihood for patients to utilise renal service. Similarly, NHIS partial coverage for hospital admissions stance 3.11 times more likely of utilizing hospital services. Patients who experienced shorter waiting time for renal treatments, had 1.9 times significantly higher likelihood of utilizing services (p=0.004). Conversely, longer waiting times were associated with decreased utilization (AOR=0.51, p=0.003), and "very long" waiting times also reflecting a higher reduced utilization (AOR=0.02, p=0.034). Conclusion: Renal patients were enrolled on the NHIS. Again, there is an influence of enabling, need and pre-disposing on utilization of renal service.