Contribution of the Ghana National Health Insurance Scheme to Inequality in Healthcare Utilisation

Abstract

Inequality in healthcare utilisation contributes to socio-economic disparities in health outcomes. The government of Ghana rolled out the Ghana National Health Insurance Scheme (NHIS) as a pro-poor health policy to reduce the financial barrier to accessing healthcare to increase healthcare utilisation, especially among the poor. Evidence showed a pro-rich utilisation inequality in Ghana prior to the nationwide start of the NHIS in 2005. This article applied the concentration index and decomposition methods to the round six of the Ghana Living Standard Survey data to investigate the contribution of the NHIS to utilisation inequality. The results showed the rich to benefit more than the poor from the NHIS and the NHIS contributed to about half of the pro-rich utilisation inequality. The NHIS increased utilisation but more so for the rich than the poor. A policy implication of the article is that pro-poorness of the NHIS might require separate NHIS schemes for the poor and non-poor to enable different policies implemented in the schemes to increase the distributional disparity of health subsidies in favour of the poor.