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Universal health coverage in the context of population ageing: what determines health insurance enrolment in rural Ghana?

Universal health coverage in the context of population ageing: what determines health insurance enrolment in rural Ghana?
Universal health coverage in the context of population ageing: what determines health insurance enrolment in rural Ghana?

Background
Population ageing presents considerable challenges for the attainment of universal health coverage (UHC), especially in countries where such coverage is still in its infancy. Ghana presents an important case study on the effectiveness of policies aimed at achieving UHC in the context of population ageing in low and middle-income countries. It has witnessed a profound recent demographic transition, including a large increase in the number of older adults, which coincided with the development and implementation of a National Health Insurance Scheme (NHIS), designed to help achieve UHC. The objective of this paper is to examine the community, household and individual level determinants of NHIS enrolment among older adults aged 50–69 and 70 plus. The latter are exempt from NHIS premium payments.
Methods
Using the Ghanaian Living Standards Survey from 2012 to 2013, determinants of NHIS enrolment for individuals aged 50–69 and 70 plus living in rural Ghana are examined through the application of multilevel regression analysis.
Results
Previous studies have mainly focused on the enrolment of young and middle aged adults and considered mainly demographic and socio-economic factors. The novel inclusion of spatial barriers within this analysis demonstrates that levels of NHIS enrolment are determined in part by the community provision of healthcare facilities. In addition, the findings imply that insurance enrolment increases with household expenditure even for those aged 70 plus who are exempt from the NHIS premium payment.
Conclusion
Adequate and appropriate infrastructure as well as health insurance is vital to ensure movement to UHC in low and middle income countries. Overall, the results confirm that there remain significant inequalities in enrolment by expenditure quintile that future policy reform will need to address.
1471-2458
1-13
Van Der Wielen, Nele
bd710148-de57-449d-9222-bbddaa7b6a52
Channon, Andrew
5a60607c-6861-4960-a81d-504169d5880c
Falkingham, Jane
8df36615-1547-4a6d-ad55-aa9496e85519
Van Der Wielen, Nele
bd710148-de57-449d-9222-bbddaa7b6a52
Channon, Andrew
5a60607c-6861-4960-a81d-504169d5880c
Falkingham, Jane
8df36615-1547-4a6d-ad55-aa9496e85519

Van Der Wielen, Nele, Channon, Andrew and Falkingham, Jane (2018) Universal health coverage in the context of population ageing: what determines health insurance enrolment in rural Ghana? BMC Public Health, 18 (657), 1-13. (doi:10.1186/s12889-018-5534-2).

Record type: Article

Abstract


Background
Population ageing presents considerable challenges for the attainment of universal health coverage (UHC), especially in countries where such coverage is still in its infancy. Ghana presents an important case study on the effectiveness of policies aimed at achieving UHC in the context of population ageing in low and middle-income countries. It has witnessed a profound recent demographic transition, including a large increase in the number of older adults, which coincided with the development and implementation of a National Health Insurance Scheme (NHIS), designed to help achieve UHC. The objective of this paper is to examine the community, household and individual level determinants of NHIS enrolment among older adults aged 50–69 and 70 plus. The latter are exempt from NHIS premium payments.
Methods
Using the Ghanaian Living Standards Survey from 2012 to 2013, determinants of NHIS enrolment for individuals aged 50–69 and 70 plus living in rural Ghana are examined through the application of multilevel regression analysis.
Results
Previous studies have mainly focused on the enrolment of young and middle aged adults and considered mainly demographic and socio-economic factors. The novel inclusion of spatial barriers within this analysis demonstrates that levels of NHIS enrolment are determined in part by the community provision of healthcare facilities. In addition, the findings imply that insurance enrolment increases with household expenditure even for those aged 70 plus who are exempt from the NHIS premium payment.
Conclusion
Adequate and appropriate infrastructure as well as health insurance is vital to ensure movement to UHC in low and middle income countries. Overall, the results confirm that there remain significant inequalities in enrolment by expenditure quintile that future policy reform will need to address.

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Accepted/In Press date: 2 May 2018
e-pub ahead of print date: 24 May 2018

Identifiers

Local EPrints ID: 421295
URI: http://eprints.soton.ac.uk/id/eprint/421295
ISSN: 1471-2458
PURE UUID: b4b8e6a5-ae00-4eb5-825a-d2ff6c6940d7
ORCID for Nele Van Der Wielen: ORCID iD orcid.org/0000-0002-0614-1491
ORCID for Andrew Channon: ORCID iD orcid.org/0000-0003-4855-0418
ORCID for Jane Falkingham: ORCID iD orcid.org/0000-0002-7135-5875

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Date deposited: 31 May 2018 16:30
Last modified: 24 Jul 2019 00:35

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