indigents and social health protection


Assessment of indigents’ enrolment into the NHIS

Setting

Rationale

 

Objectives and approach

Ghana

Indigents are the poorest and vulnerable members of the population. In 2011 the National Health Insurance Authority (NHIA) estimated that less than 2% of Ghana’s population was enrolled in the NHIS as indigent. Given that an estimated 28% of Ghanaians is living under the poverty line according to 2006 Ghana Living Standard Survey figures, then registering 2% of indigents was purported to be very low. The bid to increase the enrolment of indigents therefore has led to sharp increases in enrolment of indigents up to 14.3% in 2014. In the same year the enrolment of people less than 18 years was about 45%. So close to 60% NHIS members do not pay any premium raising concerns for the NHIS sustainability.

 

The aim of this study is to assess the factors influencing the large enrolment of indigents in different districts. We aim to determine the proportion of indigents enrolled in the NHIS, the socio-economic status of persons classified as indigents enrolled in the NHIS and the actual criteria adopted for enrolling indigents at the NHIS selected schemes. Quantitative and qualitative surveys will be carried out complemented by focus group discussions and in-depth interviews of community members who have been enrolled as indigents and the general community to understand the process of selection and enrolment.



DETERMINANTS OF COMMUNITY HEALTH FUND ENROLLMENT RENEWALS IN TANZANIA

Setting

Rationale

 

Objectives and approach

Tanzania

The Community Health Fund (CHF) is a health insurance scheme pooled at the district level, aimed at providing coverage to the informal sector amongst Tanzania’s rural areas. In exchange for an low annual premium contribution, the CHF gives members access to a range of health care services and medicines at their local public health facility. In some districts the membership covers an entire household (up to 6 individuals). Although the population targeted makes up approximately 70% of the Tanzanian population, the CHF’s coverage remains relatively low, below 10%. The problem lies in a lack of enrollment into the CHF, as well as insufficient retention of existing members. Although, the CHF would seem like a reasonable investment on paper, it may not be within the interests of the household to enroll. It therefore becomes important to understand the household’s perspective and their decision-making process when exploring the reasons for low enrollment and retention.

 

The main objective of this study is to investigate the households’ determinants of the CHF renewals. Among the main variables, socio-economic characteristics of the households, as well as household compositions, health status of the individuals and use of service are taken into account. This study adopts a quantitative approach based on a cross-sectional households’ survey conducted in Dodoma region. Approximately 400 households have been assessed along a multitude of dimensions, so as to provide as comprehensive picture of the most prominent influencers of the decision-making process. Logistic regression models including different independent variables are run to assess the extent to which they predict an individual’s decision to renew membership to the CHF.



Out-of-pocket payments of Insured Clients for health care:  Costs of health Care implication for NHIS in Ghana

Setting

Rationale

 

Objectives and approach

Ghana

Social health insurance protects clients from delays in access to health care and also from suffering costs at point of health care. The NHIS (National Health Insurance Scheme) of Ghana has however come against the challenges of sustaining the scheme and this has led to delays in payment of services provided to clients. There is thus widespread unauthorized charges that insured clients are paying out-of-pocket which should not be the case. There is anectodal evidence that these unauthorized charges are due to delays in paying claims which stalled for almost 6 to 8 months in 2015. In addition to this, another challenge is the fact that actual costs of providing care are higher than what is reimbursed to providers. Thus, funding for NHIS may not be at par with the costs of care. The question however remains what type of services are these unauthorized charges being made, who pays these charges, how much do they actually pay and what are the total costs of care (out-of-pocket payments and NHIS claims). Answers to these questions may inform policy and provide a basis for assessing the actual costs of care under the NHIS. 

 

The aim of this study is to determine costs of health care under the national health insurance from out of-pocket payments. The study will be carried out in the Ashanti, Cape Coast and Northern region. This study will be a descriptive cross sectional study involving patients accessing in-patient and out patient care services at different levels of the health system. Patients will be interviewed at the point of exit of health care. Clients will be interviewed from the lowest level of health care (CHPS) to the tertiary care (teaching hospitals). A quantitative and qualitative data collection approach will be adopted for the study. A purposive sampling of three regions with tertiary health care facilities will be done. The study will be carried out from January 2018 to June 2018.