Perceptions of healthcare quality in Ghana: Does health insurance status matter?

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From: PLoS ONE(Vol. 13, Issue 1)
Publisher: Public Library of Science
Document Type: Report
Length: 7,567 words
Lexile Measure: 1550L

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Author(s): Stephen Kwasi Opoku Duku 1,2,3,*, Edward Nketiah-Amponsah 4, Wendy Janssens 2, Menno Pradhan 2

Introduction

Background

Healthcare financing in Sub-Saharan Africa (SSA) is a grim scenario. SSA comprises 12% of the world's population and 22% of the total global disease burden [1], yet accounts for only 1% of the world's health expenditure and 2% of the global workforce in healthcare. With low per capita income, limited domestic revenue mobilisation, and ineffective health systems, countries in SSA are ill-prepared to effectively address health financing problems [2]. Governments in most SSA countries are not the sole financiers of healthcare. In these cases, more than half of the health expenditure is financed through out-of-pocket payments, which places financial burdens on households and serves as a barrier to healthcare access [3,4].

Countries in SSA, such as South Africa, Gabon, Mali, Senegal, Uganda, Tanzania, Nigeria, and Ghana have taken steps towards universal coverage by adopting risk pooling systems to provide financial protection, particularly to the poor and vulnerable in their societies [5-9]. These risk-pooling systems are either small, community-based health insurance (CBHI) schemes or social health insurance (SHI) schemes. The CBHI schemes are often voluntary and limited in geographic scope to a few rural communities with small numbers of enrolees as well as limited benefit coverage. The SHI schemes, on the other hand, have a wide scope, covering all regions in a country with subsidised premiums, government funding, and exemption policies. In some SHI schemes, enrolment is mandatory by law but voluntary in practice, as in Ghana. The benefit package covers quite comprehensive outpatient and inpatient healthcare services and medications [10,11]. Surprisingly, enrolment in most of these SHI schemes remains low even though premiums are highly subsidised. In Ghana, as of December 2013, active membership in its National Health Insurance Scheme (NHIS) was 38% of the population [12]. People's perception about the NHIS and healthcare quality has been identified as one of the factors that informs their decision to enrol or drop out of the scheme [13,14].

Prior economic literature has stipulated that the demand for health insurance is dependent on the quality of healthcare and assumes that quality is a constant, independent of health insurance status [15,16]. The evidence on the relationship between health insurance enrolment and perceived quality of healthcare is very limited. Jehu-Appiah et al [14] found that the perceptions related to providers, schemes and community attributes play an important role at varying extents in household decision to voluntarily enrol and remain enrolled in insurance schemes. A systematic review by Spaan et al. [17] of the impact of health insurance in Africa and Asia, concluded that there is a weakly positive effect of SHI and CBHI on quality of healthcare and that the effect of health insurance on quality of healthcare is woefully under researched. However, recent qualitative evidence suggests that perceived quality of healthcare is not the same across insured and uninsured patients [18,19]. A recent study by Robyn et al. [20], has also indicated that perceived quality of healthcare...

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Gale Document Number: GALE|A523354013