Impact of the National Health Insurance Scheme (NHIS) on utilization of health services in the Asante Akim South District of Ghana
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Date
2009-08-17
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Abstract
The method of financing health care determines its accessibility and affordability. Improving ways to finance health care and protect populations against the cost of illness has thus been central to health care policies of successive governments in Ghana since independence. In 2003 the Ghanaian government, as of its Growth and Poverty Reduction Strategy, initiated the National Health Insurance Scheme, a socialised mutual health insurance scheme governed by the principles of equity, solidarity and affordability, to improve the access to health care.
This study aims to evaluate the role of the District Mutual Health Insurance Scheme in enhancing access to health services in the Asante Akim South district of Ghana through lowering the financial barriers to health care. The study was a descriptive cross-sectional study supported with records review. With the aid of a closed-ended questionnaire 250 clients, aged above 18 years, accessing services at the district hospital were interviewed via systematic random sampling technique during an exit interview in the month of April 2008. The areas covered during the study included insurance coverage, barriers to enrolment in the scheme, the ability of the scheme to reach-out to the poor in the district, and the effects of the scheme on health services utilization, and individual and household data. Descriptive and inferential statistical techniques were used to analyse the data collected and the results shared with the decision makers and those who matter.
The study showed that although an estimated 55.8 percent of the district population has registered with the ; NHIS in the Asante Akim South district, only 48% of the population are card bearing members who are able to access health care services purchased through insurance. The study identified perception of respondents about the premium was seen as a major barrier to enrolment in the scheme. It also showed that 67.6 percent clients accessing health services belonged to either very poor or poor quintiles. The per capita outpatient attendance had increased to 0.41 from 0.31, representing a 31.3 percent rise in per capita attendance barely two years after the inception of the NHIS.
The inception of the NHIS has had a strong positive effect on utilization of health services in the district, with the majority of clients accessing health services under the scheme being poor. The NHIS could thus be used as a tool to attain the MDGs. The study recommends the need to for educational campaigns in the district to emphasize on changing community perception about the premium and vulnerability to illness. It also recommends increase in the premium as one of the strategies to sustain the operation of the Scheme.
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A thesis submitted to the College of Arts and Social Sciences, KNUST School of Business, 2009