Does insurance protect individuals from catastrophic payments for surgical care? An analysis of Ghana’s National Health Insurance Scheme at Korle-Bu teaching Hospital
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Date
2020-01-17
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Health Services Research
Abstract
Background: According to the World Health Organization, essential surgery should be recognized as an essential
component of universal health coverage. In Ghana, insurance is associated with a reduction in maternal mortality
and improved access to essential medications, but whether it eliminates financial barriers to surgery is unknown.
This study tested the hypothesis that insurance protects surgical patients against financial catastrophe.
Methods: We interviewed patients admitted to the general surgery wards of Korle-Bu Teaching Hospital (KBTH)
between February 1, 2017 – October 1, 2017 to obtain demographic data, income, occupation, household
expenditures, and insurance status. Surgical diagnoses and procedures, procedural fees, and anesthesia fees
incurred were collected through chart review. The data were collected on a Qualtrics platform and analyzed in
STATA version 14.1. Fisher exact and Student T-tests were used to compare the insured and uninsured groups.
Threshold for financial catastrophe was defined as health costs that exceeded 10% of household expenditures, 40%
of non-food expenditures, or 20% of the individual’s income.
Results: Among 196 enrolled patients, insured patients were slightly older [mean 49 years vs 40 years P < 0.05] and
more of them were female [65% vs 41% p < 0.05]. Laparotomy (22.2%) was the most common surgical procedure
for both groups. Depending on the definition, 58–87% of insured patients would face financial catastrophe, versus
83–98% of uninsured patients (all comparisons by definition were significant, p < .05).
Conclusion: This study—the first to evaluate the impact of insurance on financial risk protection for surgical
patients in Ghana—found that although insured patients were less likely than uninsured to face financial
catastrophe as a result of their surgery, more than half of insured surgical patients treated at KBTH were not
protected from financial catastrophe under the Ghana’s national health insurance scheme due to out-of-pocket
payments. Government-specific strategies to increase the proportion of cost covered and to enroll the uninsured is
crucial to achieving universal health coverage inclusive of surgical care.
Trial registration: Registered at www.clinical trials.gov identifier NCT03604458.
Description
Research Article
Keywords
Catastrophic health expenditures, Surgical care, Universal health coverage, Ghana
Citation
Okoroh, J., Sarpong, D.O., Essoun, S. et al. Does insurance protect individuals from catastrophic payments for surgical care? An analysis of Ghana’s National Health Insurance Scheme at Korle-Bu teaching Hospital. BMC Health Serv Res 20, 45 (2020). https://doi.org/10.1186/s12913-020-4887-2