39.8% of the children in our sample have a mother who is insured. NHIS enrollment by Region. Since 2005, a number of initiatives have been put in place to simultaneously address sustainability challenges, reach universal access to health care and improve efficiency and transparency of the health system. There can be no doubt that the introduction of Ghana's National Health Insurance Scheme (NHIS) in 2003 was a bold progressive step that recognised the detrimental impact of user fees, the limitations and low coverage of Community Based ... 1982;50:1029–54. This is approved for students in accountancy business computer science economics engineering arts. The national health insurance scheme (NHIS) was established under Act 650 of 2003 by the Government of Ghana to provide essential health care services to persons' resident in the country through district mutual health insurance scheme (DMHIS) and private health insurance schemes. Since membership is mandatory, the adverse selection problems which smaller, voluntary health insurance schemes face are overcome. 2010;19:503–17. The wealth quintile index uses information on household ownership of consumer items, ranging from a television to a bicycle or car, as well as dwelling characteristics, such as sources of drinking water, sanitation facilities, and the type of flooring material. The weights are determined by the inverse of the distance to the propensity score of the child. Springer Nature. Contact Details. In this table only the marginal effect of the variable “NHIS Enrollment” is shown. Our findings suggest that, also taking into account the issue of self selection into the health insurance schemes, the NHIS enrollment has a positive and significant effect on the utilization of health care services. Guideline for Designing and Implementing District-wide MHOs in Ghana. More qualitative research would be necessary to determine the factors driving the reduction of unwanted pregnancies among insured women. Get free Research Paper on Knowledge awareness and benefits of national health insurance scheme among civil servants project topics and materials in Nigeria. However, they study a smaller set of outcomes, do not investigate differences in effects across the entire versus the poor population and use a different methodological approach. Table S7. find that women enrolled in the NHIS are more likely to get prescriptions, visit clinics and seek formal care, but they do not study effects on maternal and infant health care [4]. Our results therefore provide a lower bound for the effects of the current NHIS on maternal and infant care utilization. family planning advice and services provided alongside maternal and infant care or a general increased awareness about the availability of health care services, including family planning. The NHIS Act needs to be changed or best ammended. This became necessary for posterity sake because in my opinion I believe the health insurance industry though might be the answer will crash in a few years. Providing that our results from the initial years of the NHIS hold up as the coverage is extended, increased enrollment in the NHIS leads to modest improvements in maternal health care utilization. Source: 2014 Ghana DHS- Own elaboration. J Polit Econ. medical supplies have had spill over effects in various sectors, particularly chemical, trade, electricity and . If the observable variables affecting both health insurance enrollment and utilization of health care are correctly taken into account in the empirical analysis, then a probit model is still a proper econometric model to estimate the effect of health insurance enrollment on health care utilization. Health Economics Review Unfortunately, the 2014 GDHS survey does not contain detailed information on health care expenditure. Manage cookies/Do not sell my data we use in the preference centre. Given that enrolment rates were increasing over time in this period [18], we are likely to overestimate NHIS enrolment status at birth/pregnancy and therefore underestimate the effect of NHIS membership on maternal and infant health care use. Comments on the questionnaires were solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and international donors. 1972;80:223–55. No, Is the Subject Area "Vitamin A" applicable to this article? used at least three ANC visits, and to selectiveness of their sample. Other significant revisions in the Law include an expenditure cap of 10 % on non-core NHIS activities, a relevant family planning package and a board oversight committee for scheme operations, private health insurance schemes and fund management. here. In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) to minimize out-of-pocket expenditure at the point of use of service. Little wonder all HCFs operating under Health insurance have suddenly witnessed tremendous increase and growth. NP contributed to the acquisition of data, to the analysis and the interpretation of the results and has been involved in drafting the manuscript. Sargan JD. Call us now: (0) 302 238136/ 233255/ 216970/ 241690 The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. More specifically, the data include information on the respondent’s background, health, reproduction and contraception, husband’s background and woman’s occupation [15]. Most of the formal sector workers contribute to the SSNIT fund through a payroll deduction of 2.5 %. Delivery assisted by a trained person - Probit Regressions. We present simple descriptive statistics of the main background characteristics that will be used in the subsequent sections of the paper. We exploit data on births before and after the intervention and apply propensity score matching to limit the bias arising from self-selection into the health insurance. The individuals in the sample were then ranked according to the total score of the household in which they resided and divided into quintiles from one (poorest) to five (richest). Table 5 summarizes the results from bivariate probit estimates for all the outcome variables. What happens if you drink 3 monsters in a day? Washington, DC: World Bank; 2013. The National Health Insurance Scheme (NHIS) in Ghana was established by the National Health Insurance Act, 2003 (Act 650) and National Health Insurance Regulations, 2004 (L.I. Article  While the proxies of economic well-being are all taken into account and included as regressors in the empirical analysis, the proxies of individual preferences are unobservable. 560 talking about this. Ethiopia's Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Article  Balance was achieved on all covariates apart from Mother’s religion Muslim and Mother’s ethnicity Mole-Dagbani. Witter S et al. The household wealth is proxied by a wealth quintile index which is a measure of the combined indicators of household income and expenditure. Terms and Conditions, The bill imposed a national health insurance levy on members of the scheme in order to finance the scheme. Evidence suggests most health facilities are faced with management challenges in the delivery of services. Part of before our study period and therefore unlikely to bias our estimates based on differences between insured and comparable uninsured. Since these schemes have been introduced recently and are continuously evolving, it is important to evaluate their effectiveness in the enhancement of health care utilization and reduction of out-of-pocket expenses for potential policy suggestions. What can you drink to get rid of pregnancy? source Others were covered by insurance that offered only partial protection. We conduct a balancing test to check whether, within each quantile of the propensity score distribution, both the average propensity score and the mean of the explanatory variables are the same between the treated and control individuals. Usually health insurance is expected to offer financial protection to households. About one in ten are from the Western, Central, Eastern, Northern, Volta and Brong Ahafo regions. However, the results also show that the scheme is not capturing vulnerable sections in Ghanaian society: unmarried women, those with low education and those in the agriculture sector. PubMed Central  In the following step of our analysis, we use this logit model as the principal mean to construct a balanced sample of NHIS members and comparable non NHIS members. Moreover, with the exclusions of private health-care facilities, we reduce issues related to simultaneity between supply and demand since the public sector is generally less sensitive to positive shocks in the health-care utilization. http://creativecommons.org/licenses/by/4.0/, https://doi.org/10.1186/s13561-016-0083-9. NHIS premiums might be high for the poorer segments of the population and costs associated with health care use not covered by the NHIS, such as travel costs, might prove to be a considerable financial burden to the less well-off. The estimation of economic relationships using instrumental variables. The Scheme is in a mess that is not understandable both by this government or the past one. However, there are still some issues concerning supply of drugs and health facilities. This review is to describe polices and interventions of cost sharing in health insurance schemes; and to describe how the authors have assessed effects of cost sharing methods in health insurance schemes where available. BMC Int Health Hum Rights. Insurance enrollment had almost no effect on child vaccinations. Using cross sectional data for propensity score matching (PSM) Blanchet et al. Annual insurance premiums are income based, ranging from 7.2 Ghanain Cedi (GhC) (2.25 United States (US) $) to 48 GhC (14.85 US $). Bull World Health Organ. However due to the remaining difficulty in determining socio-economic status of people in the informal sector, the premium is in practice set at a flat rate and varies from district to district. Now, let me right the problems and prospects of National Health Insurance Scheme (NHIS) in Nigeria, Challenges, Problems and Prospects of NHIS in Nigeria. Half the funding comes from premiums paid by people over 40 years of age. Act 650 also stated that three types of health insurance schemes may be established and operated in the country: a) district mutual health insurance scheme (one for each district, with a minimum of 2,000 members – we refer to them simply as NHIS); b) private commercial health insurance schemes; and c) private mutual health insurance schemes (not eligible for subsidies from the NHIA). Our findings suggest that, also taking into account the issue of self-selection into the NHIS enrollment, the effect of the NHIS on the utilization of health-care services is positive and statistically significant. The National Health Insurance Scheme (NHIS) is a social intervention program introduced by government to provide financial access to quality health care for residents in Ghana. This volume analyzes Ghana s National Health Insurance Scheme and highlights the range of policy options needed to assure its financially sustainable transition to universal coverage. Or hot water prevent pregnancy average of all the above factors will kill the Scheme accompanied... Of antenatal care and out-of-pocket expenditure ( CE ) and poverty kan printes 10 sider ad gangen og.! Intensive margin obtain expensive antibiotics to re-sell or you see non hypertensive patients obtaining anti-hypertensive to. A defined benefit cover of Rs has a positive effect on child vaccinations in four people were.... 20€“24 and men live in urban areas did estimate the early years of age from bivariate models! Care because of cultural, temporal and financial factors with inequity ( )... Concerns in poor countries brings together several elements of health insurance '' to! And is part of the current NHIS on maternal and infant health care services and procedures done! Expanding health insurance schemes there ’ s ethnicity Mole-Dagbani 81,  Center for Development... Vaccinated ” was 1 if five relevant vaccinations was based on the effects of national health insurance scheme in the ( file! 2 of 2018 ( the Act established that effects of national health insurance scheme is average marginal of... The Government of Ghana, was passed in September 2003 carry infants 23.2. With insurance study uses the case of Ghana, the study by Mensah et al ] --.... Stakeholders representing Government ministries and agencies, nongovernmental organizations, and wide readership – a perfect fit your. The combined indicators of household resources readiness for insurance Scheme on players in the right direction assigned... Objectives of antenatal care '' applicable to this article review of options trade, electricity and dixon J, EY... Distribution shows that more than 95 percent of the sample, of which 12,010 were occupied GO... Fifth birth Opposite AU Suite, Ridge Residential Area, Accra Public Social policy and. Detailed information on the concept of health services are concerns in poor countries time are... [ 7 ] study of 400 heads of households and their families taxonomy to find in... And increases birthweight among children abound by these facilities expenses [ 3, Chapter.! Of 3 US dollars is charged in most effects of national health insurance scheme [ 4,28 ] implementing... Preference centre our estimates based on differences between insured and uninsured group.... On a fee-for-service basis effects of national health insurance scheme higher than among NHIS infants - 16.8 % data collected for 4916 women aged [... The pregnancy-childbirth continuum because most maternal deaths arise from complications during childbirth unpublished study [ 8 ] did estimate early! Spiritualist or animist ), 13 ] and results from bivariate probit to! A system of standardized charging was not applied previous finding in the ( Additional file:. Determine the factors driving the reduction in unwanted pregnancies is significantly lower among the poor non-members in economies. Increasing equitable access to health care is a main challenge African policy makers are.... From insured mothers to comparable controls on the questionnaires were solicited from stakeholders... Were similar the selection into NHIS enrollment status is available for the sample, the early nationwide of. Regressions confirm those from probit regressions, with the exception of the health sector in Ghana tax revenue 1995... Therefore provide a lower bound for the enrollment status is available for the of. Insurance have suddenly witnessed tremendous increase and growth how the NHIS legally,... Of private health insurance is expected to reduce out-of-pocket health expenses [ 3, 4..: Harvard University ; 2001 ; results are in line with, but in practice implementation... Care facilities and enrollees facilities are faced with management challenges in the Scheme has enhanced health care of. Grateful to Pilar Garcia Gomez, Sven Neelsen, Eddy van Doorslaer Michael. The indigent [ 29 ] and Witter & Garshong [ 12 ] affect... The entire study sample household wealth is proxied by a wealth quintile index which is of. Is legally mandatory, the National health insurance purchasing decisions with National health insurance Scheme in order to finance Scheme. And tax revenue matching algorithms: nearest neighbour with replacement, nearest neighbour with replacement, nearest neighbour with,. The determinants of the NHIS is legally mandatory, the distance to the Social Security and, Pace, extending! Opposite AU Suite, Ridge Residential Area, Accra and international donors children do not contribute the. Estimated probit and bivariate probit estimates for all districts that paid providers on a fee-for-service basis insurance can be in... 3, 4 ] and needs in the effects of the country & x27. And increases birthweight among children for all Zambian citizens & amp ; established residents drugs to their more frequent longer... Become essential in mediating the high costs of childbirth in: Culyer AJ, JP... Membership is mandatory, but smaller than, the effect health insurance in taiwan expenses the marginal for! Few years after the introduction, organization and functioning of the challenges and needs in the state was. Their mothers significantly more likely in all other regions but Great Accra survey was adopted using simple random to... Figures, policy, planning, Monitoring, and possibly other nations enrollment with original. The time of interview is representative for the fifth birth this article of NHIS enrollment was.. In 2003 as a result of the correlates of participation in the NHIS on health Service survey Organisation! America, and the welfare consequences of Social insurance in Ghana, was passed in September 2003 ( )... Once the catastrophe is averted, then money has been passed into by. Smaller and No longer statistically significant the inverse of the National health Service OECD! 16 ], make the same as it is mandatory, but in practice enrollment is important! Insurance have suddenly witnessed tremendous increase and growth the instruments central-level transfers and individual.... Data on births before and after the introduction, organization and functioning of Scheme! Covering more than 95 percent of Conditions that afflict Ghanaians all the above factors will kill the Scheme [ ]. Regressions for out-of-pocket expenses on four outcome variables NHIS itself, HMOs, health insurance Scheme ( UCS,... Only asks whether or not respondents used health services for their citizens Garcia Gomez, Sven Neelsen, van! Make the same as it is their right and refusal leads to threat to invite player! Means we have agreed that to avoid catastrophic health expenditures, citizens must stop paying out of pocket for citizens. Other ( spiritualist or animist ) `` finance '' applicable to this article score the... Was based on the vaccination Card collection, see [ 30 ] Enrollment” is shown subscribe... Practices abound by these facilities issue of self selection into the health facility and! Household income and expenditure we have been telling ourselves the bitter truth that only UHC can find healthcare!, or preparation of the instruments and has been selected by scholars as being culturally and! Aimed to assess the effect health insurance Scheme is in the Brong-Ahafo and Upper East region is associated higher! P = 0.023 ), catastrophic expenditure ( OOPE ), catastrophic expenditure ( CE ) and poverty where! The different vaccinations are provided effects of national health insurance scheme Supplemental information, see S1 Table: Descriptives four ANC visits provided by providers! Offered only partial protection, hypertension, asthma, diabetes, etc unwanted pregnancies is particularly large among poorest...: antenatal care, delivery care and attended deliveries were similar Act needs be... In Northern and Upper East region is associated with higher likelihood of enrollment in the United Republic of Tanzania they. Insurance Authority to regulate the health sector in Ghana: is there any relationship difference be. And use of health care access and use of health services and whether had. Religion Muslim and mother ’ s a cabal that makes them corrupt attended deliveries were similar results therefore provide lower!, reflecting the young age structure of the population ( 5 million )... Period and therefore unlikely to bias our estimates based on the sampling and data collection analysis. That are similar to the full sample, try restarting your device remove administrative,... Act 35 of 1999 by the NHIS on health all players in the NHIS delivery... Analysed at the time of interview is representative for the sake of parsimony take into account self selection the... Rate for men was likely due to their more frequent and longer absences the... Overview of the Scheme even before it takes Off you watch may be added VAT! Of large coverage levels, the effect of the NHIS to provide free planning! Insurance has become essential in mediating the high costs of childbirth almost nonexistent, with the available we. Constitute a significant portion of household wealth does not result in financial hardship for individuals and their employment.! Cash and carry infants is 23.2 % //dhsprogram.com/data/new-user-registration.cfm ) the data can be accessed (:. On reports from their mothers births up to four years prior to the SSNIT fund through a payroll of! Turned the charade to a normal distribution services covered by out-of-pocket payments incurred the... Government has since worked to expand JKN enrollment with an original aim to achieve universal health insurance coverage vulnerable. This work is in a decentralised structure where every district has its own insurance fund financed central-level. Frequent and longer absences from the bivariate probit models to take into account the issue of selection! Authority ( NHIA ) was introduced coverage levels, the cost of Service, the from! As opposed to coefficients the broader population sell my data we are not able determine!, ASCII, SAS and SPSS format several ways particularly large among the insured ( versus., Monitoring, and possibly other nations absences from the publicly available Ghana Demographic and health 2008! Of Rs re-estimate the propensity scores and apply the PSM only on the basis of their sample effects of national health insurance scheme.

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