Who uses outpatient healthcare services under Ghana's health protection scheme and why?
BACKGROUND
The National Health Insurance Scheme (NHIS) was launched in Ghana in 2003 with the main objective of increasing utilisation to healthcare by making healthcare more affordable. Previous studies on the NHIS have repeatedly highlighted that cost of premiums is one of the major barriers for enrollment. However, despite introducing premium exemptions for pregnant women, older people, children and indigents, many Ghanaians are still not active members of the NHIS. In this paper we investigate why there is limited success of the NHIS in improving access to healthcare in Ghana and whether social exclusion could be one of the limiting barriers. The study explores this by looking at the Social, Political, Economic and Cultural (SPEC) dimensions of social exclusion.


METHODS
Using logistic regression, the study investigates the determinants of health service utilisation using SPEC variables including other variables. Data was collected from 4050 representative households in five districts in Ghana covering the 3 ecological zones (coastal, forest and savannah) in Ghana.


RESULTS
Among 16,200 individuals who responded to the survey, 54 % were insured. Out of the 1349 who sought health care, 64 % were insured and 65 % of them had basic education and 60 % were women. The results from the logistic regressions show health insurance status, education and gender to be the three main determinants of health care utilisation. Overall, a large proportion of the insured who reported ill, sought care from formal health care providers compared to those who had never insured in the scheme.


CONCLUSION
The paper demonstrates that the NHIS presents a workable policy tool for increasing access to healthcare through an emphasis on social health protection. However, affordability is not the only barrier for access to health services. Geographical, social, cultural, informational, political, and other barriers also come into play.
['Fenny|Ama P|AP|', 'Asante|Felix A|FA|', 'Arhinful|Daniel K|DK|', 'Kusi|Anthony|A|', 'Parmar|Divya|D|', 'Williams|Gemma|G|']
D000293:Adolescent D000328:Adult D000368:Aged D000553:Ambulatory Care D002648:Child D002675:Child, Preschool D003695:Delivery of Health Care D005191:Family Characteristics D005260:Female D005869:Ghana D006282:Health Personnel D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D017057:Medically Uninsured D008875:Middle Aged D009313:National Health Programs D010045:Outpatients D010342:Patient Acceptance of Health Care D011203:Poverty D012929:Psychological Distance D011640:Public Policy D011795:Surveys and Questionnaires D055815:Young Adult
Ghana National Health Insurance Utilisation Outpatient services