Towards universal health coverage: Exploring the determinants of household enrolment into National Health Insurance in the Kassena Nankana District, Ghana

摘要

This study investigates the determinants of household participation in National HealthInsurance Scheme (NHIS) in the Kassena-Nankana District in Ghana. In order to achieve thispurpose, a cross-sectional survey was used to collect data from 417 randomly selected householdheads. The results established that the NHIS is making incremental progress towards achievinguniversal health coverage because majority (67%) of the sampled population was enrolled in theNHIS. However, further analysis of the data highlighted both the challenge of achieving equityof participation in health insurance and the yawning financial barriers to accessing health carefor poor households and those employed in the informal sector. For example, majority (77%) ofuninsured households indicated that they were not enrolled in the NHIS because they could notafford the cost of insurance premiums. The research findings showed that income, socio-economicstatus (SES), formal employment, educational status, and gender amongst others, significantlydetermine household enrolment in health insurance. In order to increase the enrolment of thepoor in the NHIS, and of achieving universal health coverage, the authors recommend that thegovernment considers using payroll deductions to finance the health care needs of all formalsector employees while financing the health care of the rest of the population using tax revenues.It is also recommeded that the NHIS considers making the payment of insurance premiumflexible, such as allowing housholds to pay in installments or in kind.