Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana.
Int Health. 2024 Nov 4;16(6):610-624. doi: 10.1093/inthealth/ihad092.
This study examined the spatial distribution and factors associated with health insurance subscription among women in Ghana.
We analysed a representative sample of 9380 women aged 15-49 y from the 2014 Ghana Demographic and Health Survey. Descriptive and multilevel regression analyses were performed. The study also employed spatial analysis techniques, including spatial autocorrelation, hotspot analysis, cluster and outlier analysis, as well as geographically weighted regression to explore the geographic distribution and predictors of non-subscription to health insurance.
The analysis revealed a moderately high prevalence of health insurance subscription among women in Ghana (62.4%). The spatial analyses indicated substantial variations in health insurance subscription across different regions in Ghana. The coastal and middle zones reported higher rates of non-subscription compared with the northern zone. We observed that young women (aged 20-24 y) had a lower likelihood of subscribing compared with adolescent girls (aged 15-19 y). Also, higher educational attainment, listening to the radio, being in a marital union and higher wealth status were positively associated with health insurance subscription.
The study calls for targeted interventions and policies to promote equitable access to healthcare services, focusing on improving health infrastructure in coastal and middle zones, educational campaigns for individuals with lower education levels, leveraging media platforms for health insurance awareness and implementing equitable and affordable processes for individuals in poorer households.
本研究考察了加纳女性健康保险参保的空间分布及其影响因素。
我们对来自 2014 年加纳人口与健康调查的 9380 名 15-49 岁女性的代表性样本进行了描述性和多水平回归分析。研究还采用了空间分析技术，包括空间自相关、热点分析、聚类和异常值分析以及地理加权回归，以探讨健康保险未参保的地理分布和预测因素。
分析显示，加纳女性健康保险参保率较高（62.4%）。空间分析表明，加纳不同地区的健康保险参保率存在较大差异。沿海和中部地区的未参保率高于北部地区。我们发现，与青少年女孩（15-19 岁）相比，年轻女性（20-24 岁）的参保可能性较低。此外，较高的教育程度、听广播、已婚和较高的财富状况与健康保险参保呈正相关。
本研究呼吁采取有针对性的干预措施和政策，以促进公平获得医疗服务，重点是改善沿海和中部地区的卫生基础设施，为教育程度较低的个人开展宣传活动，利用媒体平台提高健康保险意识，并为贫困家庭的个人实施公平和负担得起的参保程序。
