To what extent does Ghana’s National Health Insurance Scheme Protect Members from Out-of-Pocket Payments in Hospitals?

Abstract

The implementation of Ghana’s National Health Insurance Scheme has resulted in a tremendous increase in access to healthcare. However, informal out-of-pocket payments are made in hospitals contrary to the tenets of the scheme. Previous studies have not examined the magnitude of these payments. A cross-sectional survey of out-patients in 17 hospitals in the Central, Brong Ahafo and Upper East Regions was conducted in 2013. Employing SPSS version 20, data was analysed using frequencies, chi-square and logistic regression. The dependent variable was out-of-pocket payment. Insurance status was the key independent variable, controlling for socio-demographic factors. The results indicate that about 10% of patients pay informal out-of-pocket fees in hospitals. The mean amount paid was GH¢13. The insured were about three times more likely than the uninsured to visit the hospital five times or more within one year. Regression analysis showed that the odd of insured patients paying informal out-of-pocket fees in hospitals is lower by 68%, holding other variables constant. Insurance status is a significant, but not sufficient factor in reducing out-of-pocket payments in hospitals. While efforts are being made to sustain the national health insurance scheme, measures must be taken to eliminate out-of-pocket payments in order to provide financial protection to the insured