Examining Health Insurance as a Strategy to Move Towards Universal Health Coverage in the Context of Population Ageing: Evidence from Ghana
Examining Health Insurance as a Strategy to Move Towards Universal Health Coverage in the Context of Population Ageing: Evidence from Ghana
Universal Health Coverage (UHC) aims to provide quality healthcare to all without financial hardship. Efforts to meet the aim of UHC will be greatly influenced by the global population ageing phenomenon. Ghana is currently undergoing a profound demographic transition, with large increases in the number of older adults. These adults require greater levels of healthcare due to increasing illness and disability as ageing occurs, which complicates progress to UHC. Ghana presents a crucial case study of the implementation of policies aimed at UHC in the context of population ageing in low and middle-income countries. This thesis examines the success of Ghana in implementing its National Health Insurance Scheme (NHIS), designed to help achieve UHC, amongst older adults. Previous studies have mainly focused on enrolment of young and middle aged adults.
Using two waves of the Demographic and Health Surveys, the WHO Study on Global Ageing and Adult Health and the Ghanaian Living Standards Survey, the correlates of NHIS enrolment among younger, middle aged and older adults are compared. Supplementary spatial and aspatial determinants of NHIS enrolment for individuals over the age of 50 are examined through the application of multilevel regression and spatial cluster analysis. Furthermore, this thesis examines the impact of NHIS membership on healthcare utilisation by applying propensity score matching.
From a policy perspective, the results of this thesis indicate that NHIS coverage does indeed increase the usage of healthcare among older adults but that geographical and socioeconomic inequalities remain in the utilisation of care and enrolment. NHIS coverage was found to differ particularly by wealth and residence. This thesis argues that the removal of financial barriers when enrolling in the NHIS is not sufficient to ensure equal usage of care among older adults. Additional policy initiatives should be considered like travel reimbursement, better provision of services and enlargement of the insurance benefit package to respond to the needs of older adults and stimulate an age-friendly health sector.
University of Southampton
Van Der Wielen, Nele
944a8211-62e0-42fa-84e2-d14e8337d581
June 2017
Van Der Wielen, Nele
944a8211-62e0-42fa-84e2-d14e8337d581
Channon, Amos
5a60607c-6861-4960-a81d-504169d5880c
Van Der Wielen, Nele
(2017)
Examining Health Insurance as a Strategy to Move Towards Universal Health Coverage in the Context of Population Ageing: Evidence from Ghana.
University of Southampton, Doctoral Thesis, 258pp.
Record type:
Thesis
(Doctoral)
Abstract
Universal Health Coverage (UHC) aims to provide quality healthcare to all without financial hardship. Efforts to meet the aim of UHC will be greatly influenced by the global population ageing phenomenon. Ghana is currently undergoing a profound demographic transition, with large increases in the number of older adults. These adults require greater levels of healthcare due to increasing illness and disability as ageing occurs, which complicates progress to UHC. Ghana presents a crucial case study of the implementation of policies aimed at UHC in the context of population ageing in low and middle-income countries. This thesis examines the success of Ghana in implementing its National Health Insurance Scheme (NHIS), designed to help achieve UHC, amongst older adults. Previous studies have mainly focused on enrolment of young and middle aged adults.
Using two waves of the Demographic and Health Surveys, the WHO Study on Global Ageing and Adult Health and the Ghanaian Living Standards Survey, the correlates of NHIS enrolment among younger, middle aged and older adults are compared. Supplementary spatial and aspatial determinants of NHIS enrolment for individuals over the age of 50 are examined through the application of multilevel regression and spatial cluster analysis. Furthermore, this thesis examines the impact of NHIS membership on healthcare utilisation by applying propensity score matching.
From a policy perspective, the results of this thesis indicate that NHIS coverage does indeed increase the usage of healthcare among older adults but that geographical and socioeconomic inequalities remain in the utilisation of care and enrolment. NHIS coverage was found to differ particularly by wealth and residence. This thesis argues that the removal of financial barriers when enrolling in the NHIS is not sufficient to ensure equal usage of care among older adults. Additional policy initiatives should be considered like travel reimbursement, better provision of services and enlargement of the insurance benefit package to respond to the needs of older adults and stimulate an age-friendly health sector.
Text
PhD corrected 2017
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Submitted date: November 2016
Published date: June 2017
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Local EPrints ID: 457275
URI: http://eprints.soton.ac.uk/id/eprint/457275
PURE UUID: 90a6caf1-fe9f-41ea-ad7a-c60febace78c
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Date deposited: 30 May 2022 16:55
Last modified: 17 Mar 2024 02:59
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Author:
Nele Van Der Wielen
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