Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Socinstrasse 57, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Health Policy Plan. 2019 Oct 1;34(8):582-594. doi: 10.1093/heapol/czz079.
In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) to move towards Universal Health Coverage. NHIS enrolment is mandatory for all Ghanaians, but the most recent estimates show that coverage stands under 40%. The evidence on the relationship between socio-economic characteristics and NHIS enrolment is mixed, and comes mainly from studies conducted in a few areas. Therefore, in this study we investigate the socio-economic determinants of NHIS enrolment using three recent national household surveys. We used data from the Ghanaian Demographic and Health Survey conducted in 2014, the Multiple Indicator Cluster Survey conducted in 2011 and the sixth wave of the Ghana Living Standard Survey conducted in 2012-13. Given the multilevel nature of the three databases, we use multilevel logistic regression models to estimate the probability of enrolment for women and men separately. We used three levels of analysis: geographical clusters, household and individual units. We found that education, wealth, marital status-and to some extent-age were positively associated with enrolment. Furthermore, we found that enrolment was correlated with the type of occupation. The analyses of three national household surveys highlight the challenges of understanding the complex dynamics of factors contributing to low NHIS enrolment rates. The results indicate that current policies aimed at identifying and subsidizing underprivileged population groups might insufficiently encourage health insurance enrolment.
2003 年，加纳实施了国家健康保险计划（NHIS），以实现全民健康覆盖。NHIS 参保对所有加纳人都是强制性的，但最近的估计显示，覆盖率不足 40%。关于社会经济特征与 NHIS 参保之间关系的证据存在分歧，主要来自少数几个地区的研究。因此，在这项研究中，我们使用最近的三次全国家庭调查来研究 NHIS 参保的社会经济决定因素。我们使用了 2014 年进行的加纳人口与健康调查、2011 年进行的多指标类集调查和 2012-13 年进行的加纳生活水平调查第六轮的数据。鉴于这三个数据库的多层次性质，我们分别使用多层次逻辑回归模型来估计女性和男性的参保概率。我们使用了三个分析层次：地理集群、家庭和个人单位。我们发现，教育、财富、婚姻状况——在一定程度上还有年龄——与参保呈正相关。此外，我们还发现，参保与职业类型有关。对三次全国家庭调查的分析突出了理解导致 NHIS 参保率低的复杂因素动态的挑战。结果表明，当前旨在确定和补贴弱势群体的政策可能不足以鼓励医疗保险参保。
