Factors Contributing to the Low Registration of National Health Insurance Scheme (NHIS) in Kassena-Nankana District (KND) in Upper East Region, Ghana

Abstract

Health insurance is a method of financing health care in which payment for health care is made at a time that one is sick. It is a policy of the Government of Ghana to replace the previous cash and carry system with the Mutual Health Insurance Scheme since the previous method makes health care financially inaccessible to the citizenry especially the poor and the vulnerable. Even though much education on the scheme has been carried out in the district since its inception through durbars, use of the local FM station, organized talks at the churches and the health facilities; registration in the scheme in the KND is still low, only 8.34% of the inhabitants have registered as compared to the national target of 50% registration by the end of 2006. Therefore the purpose of this study was to determine the factors contributing to the low participation in the scheme. Some of the factors studied include age group, gender, level of education and occupation of the household heads who have not registered and registered with the scheme. Geographical accessibility of health facilities within the district, the method of payment of the premium that the inhabitants prefer and the community’s participation in the establishment of the scheme were also studied. The assumption posed in the study was that there was no difference in the characteristics of household heads who have not registered and those who have registered with the scheme. Hypothesis tested was that there is difference between characteristics of household heads who have registered and not registered. The study was a case control study across the whole Kassena-Nankana District (KND). This method was chosen because it provides the means of comparing the characteristics of those who have not registered (cases) with those who have registered (controls). The cases were all household heads between the ages of 18 years and 69 years who have not register with the National Health Insurance Scheme (NHIS) and reside permanently in KND whilst the controls were all household heads with the same characteristics but who have registered with the scheme. The method used was random sampling using Epi Info. The sample size was 320 consisting of 160 each of cases and controls. The nearest neighbour who is of the same sex as the case was selected as the control. The result from the study shows that there are differences in characteristics of the household heads who have not registered and those who have registered. It was observed that within KND, females were 75% times more likely to register in the scheme as compared to males (OR= 0.25, p-value= 0.02). Also household heads with 3 or more dependents were 85% more likely to register with the scheme as compared to those with 2 or less. On the other hand household heads within the age groups 40-49 and 60-69 years were 5.21 times more likely not to register as compared to those within 20-29 years. Again as compared to civil servants, farmers (5.73 times) and unemployed (1.97 times) are less likely to register. With reference to community factors, it was revealed that those who have access to health facilities are rather 3.34 times more likely not to register as compared those who do not have access. Community members who believe that they a role to play in establishing the scheme were 73% more likely to register than those who believe they do not have any role to play. Lastly the respondents who obtained all their drugs at the health facilities during the last six months are 3.55 times more likely not to register. It is therefore recommended the scheme manager and his staff should intensify their education to convince the males especially to register. The education campaign should emphasize that the community members have a role to play to make the scheme successful. Lastly, the scheme manager should employ the necessary mechanisms to be able to identify all the core poor within the district so as to enjoy the exemption policy instituted by the government.