Alhassan Yussif Nagumse
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Int J Health Plann Manage. 2018 Oct;33(4):e930-e943. doi: 10.1002/hpm.2563. Epub 2018 Jul 3.
Attempts to study the determinants of health insurance enrollment in resource-poor settings have often given less consideration to the potential influence of informal risk-sharing systems on individuals and households' decisions about health insurance. This paper contributes to existing discussions in this area by examining the effect of informal financial support for health care, an example of informal risk-sharing arrangement, on enrollment in the Ghana National Health Insurance Scheme (NHIS). It is based on a mixed-methods research in Tamale metropolis of northern Ghana. The study found widespread availability and reliance on informal support among low-income households to finance out-of-pocket health-care expenditure. Informal financial support for enrollment into the NHIS was noted to be less available. The study further found less strong but suggestive evidence that the perceived availability of informal financial support for health care by individuals diminishes their enrollment in the NHIS. The paper emphasizes the need for theory and policy on health insurance uptake in resource-constrained settings to consider existing informal risk-sharing arrangements as much as other known determinants of enrollment.
在资源匮乏地区，研究医疗保险参保决定因素时，往往较少考虑非正式风险分担体系对个人和家庭医疗保险决策的潜在影响。本文通过研究非正式医疗费用支持（一种非正式风险分担安排）对加纳国家医疗保险计划（NHIS）参保率的影响，为该领域的现有讨论做出了贡献。研究基于对加纳北部塔马利市的混合方法研究。研究发现，低收入家庭在支付自付医疗费用方面普遍存在非正式支持且依赖这种支持。而用于NHIS参保的非正式财务支持则较少。研究还发现，虽证据不太有力但具有一定暗示性，即个人认为可获得的非正式医疗费用支持会降低他们参加NHIS的比例。本文强调，在资源有限的环境中，关于医疗保险参保的理论和政策需要像考虑其他已知参保决定因素一样，充分考虑现有的非正式风险分担安排。
