THE EFFECTS OF NATIONAL HEALTH INSURANCE SCHEME ON OUTPATIENT UTILIZATION AND EXPENDITURE IN GHANA: A CASE STUDY OF MFANTSEMAN MUNICIPALITY

ABSTRACT

Recognizing the potential of Mutual Health Organizations (MHOs) to eliminate user fees and increase utilization of health care services in the country, the government of Ghana enacted the National Health Insurance Act in 2003, mandating the establishment of district-wide MHOs. The purpose of this study was to analyze the effects of the National Health Insurance Scheme (NHIS) on the probability of utilizing outpatient care and expenditure in the Mfantseman Municipality of the Central Region of Ghana.

Data for the study was obtained through a household survey. In all 384 individuals were randomly selected and interviewed. The main research instrument for the study was an interview. Logit regression model was used to analyze the probability of utilizing outpatient care and the determinants of enrolment in health insurance. Again, a linear regression model was used to analyze the impact of NHIS memberships on out-of-pocket health care expenditure.

The study reveals that insured respondents were more likely to utilize outpatient care and pay less than uninsured respondents. Public education should be embarked upon to encourage families to enroll, as the scheme has an impact on poverty. Factors which influence enrolment at the individual/household level were age, sex (male), literacy/education, income and wealth. Policy makers/donors should be aware that it may be difficult to reach the poorest part of the population.

In order to reach them the cost of participation would have to be reduced or the government would have to subsidize the premiums of indigents.