{"title":"Sustainability of national health insurance scheme in Ghana: what is the effect of enrolment on retention and what are the constraints?","authors":"Nicholas Kwame Essah","doi":"10.1186/s13561-025-00619-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Globally, health remains an important issue on governments agenda. Subsequently, the health insurance scheme was introduced in Ghana to reduce out-of-pocket payments for healthcare delivery. However, there are several challenges facing the scheme including continuous membership (retention) and financial constraints. These issues pose threat to the sustainability of the scheme. This study examined the effect of NHIS enrolment status on NHIS retention status in Ghana. The study further assesses the socio-demographic determinants of the NHIS retention and the major constraints in Ghana.</p><p><strong>Methods: </strong>The expected utility theory of decision-making on health insurance underpins the study. The study's sample is drawn from the Ghana Living Standards Survey Round 7 (2016/2017) and the Heckman probit estimation technique is used to address the potential endogeneity in the sample selection process.</p><p><strong>Results: </strong>There is positive effect of NHIS enrolment on the NHIS retention decision. Again, the study shows that the NHIS retention is driven by factors such as being female, being married, higher education, urban locality and household expenditure affect NHIS retention status positively. However, younger age and household size were found to deter NHIS retention status. The study further identified finance as the main constraint for the NHIS non- retention in Ghana (66.6%) followed by poor service delivery (12.5%). The financial constraint was higher for females (69.1%) than males (64.0%). It is also higher for rural areas (75.4%) than urban areas (48.8%).</p><p><strong>Conclusions: </strong>Government should continue to strengthen efforts towards improving the quality of NHIS service delivery and monitor the implementation particularly in the rural areas. Again, government should continue to subsidize the health insurance premium particularly for the poor and the youth in Ghana. Also, public education should continue to be strengthened on the NHIS renewal process in Ghana.</p>","PeriodicalId":46936,"journal":{"name":"Health Economics Review","volume":"15 1","pages":"64"},"PeriodicalIF":3.3000,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275349/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Economics Review","FirstCategoryId":"96","ListUrlMain":"https://doi.org/10.1186/s13561-025-00619-6","RegionNum":3,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ECONOMICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Globally, health remains an important issue on governments agenda. Subsequently, the health insurance scheme was introduced in Ghana to reduce out-of-pocket payments for healthcare delivery. However, there are several challenges facing the scheme including continuous membership (retention) and financial constraints. These issues pose threat to the sustainability of the scheme. This study examined the effect of NHIS enrolment status on NHIS retention status in Ghana. The study further assesses the socio-demographic determinants of the NHIS retention and the major constraints in Ghana.
Methods: The expected utility theory of decision-making on health insurance underpins the study. The study's sample is drawn from the Ghana Living Standards Survey Round 7 (2016/2017) and the Heckman probit estimation technique is used to address the potential endogeneity in the sample selection process.
Results: There is positive effect of NHIS enrolment on the NHIS retention decision. Again, the study shows that the NHIS retention is driven by factors such as being female, being married, higher education, urban locality and household expenditure affect NHIS retention status positively. However, younger age and household size were found to deter NHIS retention status. The study further identified finance as the main constraint for the NHIS non- retention in Ghana (66.6%) followed by poor service delivery (12.5%). The financial constraint was higher for females (69.1%) than males (64.0%). It is also higher for rural areas (75.4%) than urban areas (48.8%).
Conclusions: Government should continue to strengthen efforts towards improving the quality of NHIS service delivery and monitor the implementation particularly in the rural areas. Again, government should continue to subsidize the health insurance premium particularly for the poor and the youth in Ghana. Also, public education should continue to be strengthened on the NHIS renewal process in Ghana.
期刊介绍：
Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
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