Section for Health Promotion and Health Services Research, Department of Public Health, Faculty of Health, Aarhus University, Vennelyst Boulevard 6, 8000, Arhus C, Denmark.
Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Legon, Accra, Ghana.
Int J Equity Health. 2015 Jan 17;14:2. doi: 10.1186/s12939-014-0130-2.
Access to health insurance is expected to have positive effect in improving access to healthcare and offer financial risk protection to households. Ghana began the implementation of a National Health Insurance Scheme (NHIS) in 2004 as a way to ensure equitable access to basic healthcare for all residents. After a decade of its implementation, national coverage is just about 34% of the national population. Affordability of the NHIS contribution is often cited by households as a major barrier to enrolment in the NHIS without any rigorous analysis of this claim. In light of the global interest in achieving universal health insurance coverage, this study seeks to examine the extent to which affordability of the NHIS contribution is a barrier to full insurance for households and a burden on their resources.
The study uses data from a cross-sectional household survey involving 2,430 households from three districts in Ghana conducted between January-April, 2011. Affordability of the NHIS contribution is analysed using the household budget-based approach based on the normative definition of affordability. The burden of the NHIS contributions to households is assessed by relating the expected annual NHIS contribution to household non-food expenditure and total consumption expenditure. Households which cannot afford full insurance were identified.
Results show that 66% of uninsured households and 70% of partially insured households could afford full insurance for their members. Enroling all household members in the NHIS would account for 5.9% of household non-food expenditure or 2.0% of total expenditure but higher for households in the first (11.4%) and second (7.0%) socio-economic quintiles. All the households (29%) identified as unable to afford full insurance were in the two lower socio-economic quintiles and had large household sizes. Non-financial factors relating to attributes of the insurer and health system problems also affect enrolment in the NHIS.
Affordability of full insurance would be a burden on households with low socio-economic status and large household size. Innovative measures are needed to encourage abled households to enrol. Policy should aim at abolishing the registration fee for children, pricing insurance according to socio-economic status of households and addressing the inimical non-financial factors to increase NHIS coverage.
人们期望获得医疗保险能够改善医疗服务的可及性，并为家庭提供财务风险保护。加纳于 2004 年开始实施国家健康保险计划（NHIS），旨在确保所有居民都能公平地获得基本医疗保健。在实施十年后，全国覆盖率仅为全国人口的 34%左右。家庭经常提到 NHIS 缴费的负担能力是阻碍他们参加 NHIS 的主要障碍，但没有对这一说法进行严格的分析。鉴于全球对实现全民健康保险覆盖的关注，本研究旨在考察 NHIS 缴费的负担能力在多大程度上成为家庭全面保险的障碍，并对其资源造成负担。
本研究使用了 2011 年 1 月至 4 月期间在加纳三个地区进行的一项涉及 2430 户家庭的横断面家庭调查的数据。采用基于家庭预算的方法，根据可负担性的规范定义来分析 NHIS 缴费的可负担性。通过将预期的年度 NHIS 缴费与家庭非食品支出和总消费支出进行比较，评估 NHIS 缴费对家庭的负担。确定无法负担全额保险的家庭。
结果表明，66%的未参保家庭和 70%的部分参保家庭有能力为其成员全额参保。将所有家庭成员纳入 NHIS 将占家庭非食品支出的 5.9%或总支出的 2.0%，但在第一（11.4%）和第二（7.0%）社会经济五分位数的家庭中更高。所有被确定为无法负担全额保险的家庭都在两个较低的社会经济五分位数中，并且家庭规模较大。与保险公司和卫生系统问题属性有关的非财务因素也会影响 NHIS 的参保。
对于社会经济地位较低和家庭规模较大的家庭来说，全额保险的负担能力将是一个负担。需要采取创新措施鼓励有能力的家庭参保。政策应着眼于取消儿童注册费，根据家庭的社会经济地位为保险定价，并解决不利于非财务因素，以提高 NHIS 的覆盖率。
