Household dynamics and national health insurance scheme enrollment: Findings from a baseline study in rural Ghana

Abstract

The United Nations Sustainable Development Goal 3 (Target 8) requires that all individuals and communities receive healthcare services without constraints. Over the past few decades, geographical access to healthcare services in Ghana has improved. However, economic access had been a major hindrance to healthcare utilization until the introduction of the National Health Insurance Scheme (NHIS). To enroll in the NHIS and qualify to access healthcare services, one is required to pay a premium or renew their expired membership. Payment of premium or renewal of membership, among other factors, has been one of the major challenges inhibiting enrollment into the NHIS, thereby hindering access to healthcare. This study seeks to examine factors that are associated with NHIS enrollment in a rural district of Ghana. The findings will enable us to provide context-specific interventions to improve NHIS enrollment to overcome economic challenges in respect of healthcare access. The study relied on the Health Belief Model (HBM). Data for this analysis came from the Afadjato South District Health and Demographic Surveillance System (HDSS). Under the system, individuals and their households were enumerated. Socio-demographic information was collected on individuals and households. Information on National Health Insurance enrollment was also collected for all individuals. The simple logistic regression method was used for the analysis to examine the factors that are associated with NHIS enrollment. In all, 11,082 individuals were part of this analysis, out of which 65% had valid NHIS enrollment. The results indicated that higher household socio-economic status (SES) was associated with higher odds of NHIS enrollment. Other variables that showed association with NHIS enrollment include individuals in female-headed households and individuals in households with educated heads. In addition, being in a large household, being an urban resident, and being a female were all found to be associated with higher odds of NHIS enrollment. The study concluded that household characteristics are important predictors of NHIS enrollment. In particular, NHIS registration and renewal is affected by household SES, where poor households are less likely to enroll. Therefore, policies aimed at getting more people to enroll in the NHIS should consider targeting poor and vulnerable households for support, such as premium exemptions or cash transfers to the poor and vulnerable groups in the population. Also, public education on the health benefits of NHIS enrollment should be intensified, particularly among rural and uneducated members of the population.