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Out-of-pocket payment for primary healthcare in the era of national health insurance: Evidence from northern Ghana

Author

Listed:
  • Edmund Wedam Kanmiki
  • Ayaga A Bawah
  • James F Phillips
  • John Koku Awoonor-Williams
  • S Patrick Kachur
  • Patrick O Asuming
  • Caesar Agula
  • James Akazili

Abstract

Background: Ghana introduced a national health insurance program in 2005 with the goal of removing user fees, popularly called “cash and carry”, along with their associated catastrophic and impoverishment effects on the population and ensuring access to equitable health care. However, after a decade of implementation, the impact of this program on user fees and out-of-pocket payment (OOP) is not properly documented. This paper contributes to understanding the impact of Ghana’s health insurance program on out-of-pocket healthcare payments and the factors associated with the level of out-of-pocket payments for primary healthcare in a predominantly rural region of Ghana. Methods: Using a five-year panel data of revenues accruing to public primary health facilities in seven districts, We employed mean comparison tests (t-test) to examine the trend in revenues accruing from out-of-pocket payments vis-à-vis health insurance claims for health services, medication, and obstetric care. Furthermore, generalized estimation equation regression models were used to assess the relationship between explanatory variables and the level of out-of-pocket payments and health insurance claims. Results: Out-of-pocket payment for health services and medications declined by 63% and 62% respectively between 2010 and 2014. Insurance claims however increased by 16% within the same period. There was statistically a significant mean reduction in out-of-pocket payment over the period. Factors significantly associated with out-of-pocket payments in a given district are the number of community health facilities, availability of a district hospital and the year of observation. Conclusion: The study provides evidence that Ghana’s national health insurance program is significantly contributing to a reduction in out-of-pocket payment for primary healthcare in public health facilities. Efforts should therefore be put in place to ensure the sustainability of this policy as a major pathway for achieving universal health coverage in Ghana.

Suggested Citation

  • Edmund Wedam Kanmiki & Ayaga A Bawah & James F Phillips & John Koku Awoonor-Williams & S Patrick Kachur & Patrick O Asuming & Caesar Agula & James Akazili, 2019. "Out-of-pocket payment for primary healthcare in the era of national health insurance: Evidence from northern Ghana," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-11, August.
    • Handle: RePEc:plo:pone00:0221146
    DOI: 10.1371/journal.pone.0221146
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    References listed on IDEAS

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    1. Pablo Gottret & George J. Schieber & Hugh R. Waters, 2008. "Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income Countries," World Bank Publications - Books, The World Bank Group, number 6442.
    2. Edmund Wedam Kanmiki & James Akazili & Ayaga A Bawah & James F Phillips & John Koku Awoonor-Williams & Patrick O Asuming & Abraham R Oduro & Moses Aikins, 2019. "Cost of implementing a community-based primary health care strengthening program: The case of the Ghana Essential Health Interventions Program in northern Ghana," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-15, February.
    3. Philip Dalinjong & Alexander Laar, 2012. "The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana," Health Economics Review, Springer, vol. 2(1), pages 1-13, December.
    4. John Koku Awoonor-Williams & James F. Phillips & Ayaga A. Bawah, 2016. "Catalyzing the scale-up of community-based primary healthcare in a rural impoverished region of northern Ghana," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(4), pages 273-289, October.
    5. Ekman, Bjorn, 2007. "Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country," Health Policy, Elsevier, vol. 83(2-3), pages 304-313, October.
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