Determinants of health insurance enrolment in Ghana: evidence from three national household surveys
Objectives and approach
In low and middle income countries one of the challenges to move towards Universal Health Coverage is including vulnerable populations in social health protection schemes such as social health
insurance. Since 2003, the Government of Ghana has been implementing a single National Health Insurance Scheme (NHIS) that requires each Ghanaian citizen to join either one of the district level
mutual health insurance schemes, or the private commercial and private mutual health insurance schemes. Each of the schemes is required to provide basic healthcare benefits. However, the NHIS
coverage is still less than 40%. Several studies have attempted to assess the relation between socioeconomic characteristics and the probability of enrolling into the NHIS. Yet so far the
evidence has been mixed and emerging mainly from rather small studies conducted in a few geographical areas.
In this study we investigate the socioeconomic determinants of enrollment into the Ghanaian NHIS using the available national household surveys. Namely, we used data of the latest Ghanaian
Demographic and Health Survey (DHS) conducted in 2014, the Multiple Indicator Cluster Surveys (MICs) of 2011, and the 6th wave of the Ghana Living Standard Survey (GLSS) of 2012/13 to estimate
the determinants of NHIS enrollment. These surveys are nationally representative and they contain information on individual characteristics and NHIS enrollment. Using logistic regression models
we estimate the probability of being insured for both women and men separately. All models’ specifications are run with the sampling weights provided in the surveys. Several robustness tests are
conducted to validate results.