Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
PLoS One. 2019 Aug 20;14(8):e0221146. doi: 10.1371/journal.pone.0221146. eCollection 2019.
Ghana introduced a national health insurance program in 2005 with the goal of removing user fees, popularly called "cash and carry", along with their associated catastrophic and impoverishment effects on the population and ensuring access to equitable health care. However, after a decade of implementation, the impact of this program on user fees and out-of-pocket payment (OOP) is not properly documented. This paper contributes to understanding the impact of Ghana's health insurance program on out-of-pocket healthcare payments and the factors associated with the level of out-of-pocket payments for primary healthcare in a predominantly rural region of Ghana.
Using a five-year panel data of revenues accruing to public primary health facilities in seven districts, We employed mean comparison tests (t-test) to examine the trend in revenues accruing from out-of-pocket payments vis-à-vis health insurance claims for health services, medication, and obstetric care. Furthermore, generalized estimation equation regression models were used to assess the relationship between explanatory variables and the level of out-of-pocket payments and health insurance claims.
Out-of-pocket payment for health services and medications declined by 63% and 62% respectively between 2010 and 2014. Insurance claims however increased by 16% within the same period. There was statistically a significant mean reduction in out-of-pocket payment over the period. Factors significantly associated with out-of-pocket payments in a given district are the number of community health facilities, availability of a district hospital and the year of observation.
The study provides evidence that Ghana's national health insurance program is significantly contributing to a reduction in out-of-pocket payment for primary healthcare in public health facilities. Efforts should therefore be put in place to ensure the sustainability of this policy as a major pathway for achieving universal health coverage in Ghana.
加纳于 2005 年推出了国家健康保险计划，旨在取消俗称“现金自付”的用户费用及其对人口的灾难性和贫困化影响，并确保公平获得医疗保健。然而，在实施十年后，该计划对用户费用和自付费用（OOP）的影响并未得到妥善记录。本文有助于了解加纳健康保险计划对自付医疗保健费用的影响，以及与加纳主要农村地区初级保健自付费用水平相关的因素。
我们使用七个区公立初级卫生保健机构五年的收入面板数据，采用均值比较检验（t 检验），考察了健康保险索赔和自付费用在卫生服务、药物和产科保健方面的收入趋势。此外，还使用广义估计方程回归模型评估了解释变量与自付费用和健康保险索赔水平之间的关系。
2010 年至 2014 年期间，医疗服务和药物的自付费用分别下降了 63%和 62%。同期，保险索赔增长了 16%。在整个期间，自付费用呈显著下降趋势。在给定的区，与自付费用显著相关的因素是社区卫生设施的数量、区医院的可用性和观察年份。
研究提供了证据表明，加纳的国家健康保险计划正在显著促进公立卫生设施初级保健自付费用的减少。因此，应努力确保该政策的可持续性，作为加纳实现全民健康覆盖的主要途径。
