Assessing the Relationship between Enrollment on to a Health Insurance Package and Health-Seeking Behavior among Doctors in the Greater-Accra Region

Abstract

Introduction: Healthcare workers, especially doctors, face high occupational risks that increase their susceptibility to illness, yet literature shows they often exhibit poor health-seeking behavior. Despite their knowledge of the healthcare system, it is unclear whether doctors themselves subscribe to health insurance packages that facilitate appropriate health-seeking behavior. This gap is particularly relevant in Ghana as the NHIS, and universal health coverage initiatives advance. Examining how insurance enrollment influences doctors’ health-seeking behavior in the Greater Accra Region is therefore essential for guiding policy and enhancing physician well-being. Methodology: A quantitative cross-sectional study was conducted in three hospitals in the Greater-Accra region among 361 doctors. A structured questionnaire was used to collected data from 361 medical doctors proportionately sampled from the Korle-Bu Teaching Hospital, Achimota Hospital and University Hospital, Legon. Independent variables included sociodemographic characteristics of participants and their health insurance status. The dependent variables were burden of out-of-pocket payment for healthcare and health-seeking behavior of medical doctors. The data was analyzed using STATA 17. Descriptive analysis of independent variables such as sociodemographic characteristics was conducted. These were reported as frequencies and percentages and presented in tables and graphs. The distribution of the reasons for enrollment or non-enrollment among the insured and uninsured respectively, was presented in tables as frequencies and percentages. Chi-square analysis and Logistic regression analysis were done to determine the association between the dependent and independent variables. A p-value less than 0.05 was considered as statistically significant. Results: The mean age of respondents was 30.1 years with approximately 63% of them insured. There was a high rate of out-of-pocket payment among doctors with as much as 10.5% of them having catastrophic health expenditure at a threshold of 10% of their total income. The burden of out-of-pocket payment was found to be significantly associated with health insurance enrollment (λ=8.579; p-value=0.035). Reducing out-of-pocket payments was the commonest factor (74.3% of the insured) associated with health insurance enrollment whilst poor coverage and service provided was the most cited reason (45.9% of the uninsured) for not enrolling on a health insurance. Most of the doctors (52.6%) were found to have poor health-seeking behavior with more than a third engaging in self-medication (50.4%) and informal consultation with colleagues (36.6%) as their main means of seeking care when unwell. There was a strong association between health insurance status and health-seeking behavior showing that those insured had more than twice higher odds of good health-seeking behavior compared to the uninsured (aOR = 2.25, 95% CI: 1.43–3.55 p-value < 0.001).Conclusion: Health insurance enrollment has been shown to have higher odds of reducing the burden of out-of-pocket payment and improving health-seeking behavior. There is the need for tailored comprehensive health insurance packages and promotion of benefits of insurance packages among healthcare workers including doctors.