Premium exemptions and active health insurance membership among teenage migrant head porters in Ghana: a cross-sectional study

Ghana’s national health insurance scheme (NHIS) aims to provide financial risk protection to vulnerable populations by making provisions for premium  exemptions for all people below 18 years. This study assessed the factors associated with active insurance membership and access to premium  exemptions among teenage migrant head porters in Ghana. Data collected from 257 migrant female head porters (10-17 years old) in Accra and Kumasi  in a cross-sectional survey were analysed using descriptive statistics and regression models. Only 25% of participants had active membership cards  although about 54% had ever registered with the NHIS. Among registered members, only 40% benefited from NHIS premium exemptions as per the insurance policy. Respondents who benefited from premium exemptions were more likely to maintain active membership (OR=3.58, p-value<0.01).  Relatively higher income earners (OR=2.72, p-value<0.05) and those who migrated to Kumasi (OR=5.17, p-value<0.01) were more likely to maintain active  membership. Although benefiting from premium exemptions improves active enrolment, many migrant teenage head porters were unable to benefit  from exemptions. We recommend that the National Health Insurance Authority takes pragmatic steps to identify and enrol all female head porters below  18 years to improve their access to healthcare.