Sociodemographic determinants of health insurance enrolment and dropout in urban district of Ghana: a cross-sectional study
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Date
2019-06-27
Journal Title
Journal ISSN
Volume Title
Publisher
Health Economics Review
Abstract
Background: Earlier studies have found significant associations between sociodemographic factors and enrolment
in the National Health Insurance Scheme (NHIS) in Ghana. These studies were mainly household surveys in relatively
rural areas with high incidence of poverty. To expand the scope of existing evidence, this paper examines policy
design factors associated with enrolment and dropout of the scheme in an urban poor district using routine
secondary data.
Methods: This study is a cross-sectional quantitative analysis of 2014–2016 NHIS enrolment data of the Ashiedu
Keteke district office. Descriptive and multivariate logistic regression analyses were performed to examine
sociodemographic factors associated with NHIS enrolment and dropout.
Results: A total of 215,724 individuals enrolled in the NHIS over the period under study, of which 98,232 (46%)
were new members. About 41% of existing members in 2014 dropped out of the NHIS in 2015 and 53% of those
in 2015 dropped out in 2016. The indigents (core poor) are significantly more likely to enrol and to drop out of the
NHIS. However, the males, informal sector employees, social security and national insurance trust (SSNIT)
contributors, and the aged (70+ years) are significantly less likely to enrol in the NHIS but more likely to retain
coverage.
Conclusions: A considerable number of members are dropping out of the NHIS. The indigents in particular, are
increasingly enrolling in and dropping out of the NHIS whilst the males, informal sector employees, SSNIT
contributors and the aged are not enrolling as expected but increasingly retaining coverage. Policy reforms to
ensuring continued growth towards realization of universal health coverage should take these factors into
consideration.
Description
Research Article
Keywords
Enrolment, Dropout, National Health Insurance, Urban district, Ghana