The role of universal health coverage in secondary prevention: A case study of Ghana’s National Health Insurance Scheme and early-onset hypertension

Abstract

Background

Launched in 2003, Ghana’s National Health Insurance Scheme (NHIS) was a move towards Universal Health Coverage. There is a dearth of studies that have since investigated the effect of the scheme on non-communicable diseases (NCDs) like hypertension. While a major cause of mortality and morbidity, hypertension remains mostly undiagnosed in Ghana. Secondary prevention comprising early detection and prompt treatment is, hence, important in reducing disease burden. This study assessed the association between active NHIS membership and the likelihood of having early-onset hypertension detected and treated.

Methods

A cross-sectional analysis of the 2014 Ghana Demographic and Health Survey (male dataset) was conducted. Unadjusted analysis used binary logistic regression with active NHIS membership as the independent variable and detection of early-onset hypertension as the dependent variable. Early-onset hypertension was defined as the onset of hypertension at 55 years or younger. Covariates for the adjusted regression models were age, BMI, smoking status, place of residence, wealth, and education level. The association between membership and treatment was also assessed.

Results

Unadjusted and adjusted results showed that the odds of early-onset hypertension being detected in participants with active NHIS membership were respectively 2.4 (95 % CI:1.56 – 3.59, p = 0.000) and 2.2 (95 % CI 1.43 – 3.24, p = 0.000) that of those without active membership. There was no significant association between membership and treatment.

Conclusion

This study suggests that NHIS membership may play a beneficial role in the secondary prevention of NCDs in Ghana. Further research is, nevertheless, needed to understand how membership, NCDs, and other contextual factors are interrelated.