Towards universal health coverage: Exploring the determinants of household enrolment into National Health Insurance in the Kassena Nankana District, Ghana

Abstract

This study investigates the determinants of household participation in National Health Insurance Scheme (NHIS) in the Kassena-Nankana District in Ghana. In order to achieve this purpose, a cross-sectional survey was used to collect data from 417 randomly selected household heads. The results established that the NHIS is making incremental progress towards achieving universal health coverage because majority (67%) of the sampled population was enrolled in the NHIS. However, further analysis of the data highlighted both the challenge of achieving equity of participation in health insurance and the yawning financial barriers to accessing health care for poor households and those employed in the informal sector. For example, majority (77%) of uninsured households indicated that they were not enrolled in the NHIS because they could not afford the cost of insurance premiums. The research findings showed that income, socio-economic status (SES), formal employment, educational status, and gender amongst others, significantly determine household enrolment in health insurance. In order to increase the enrolment of the poor in the NHIS, and of achieving universal health coverage, the authors recommend that the government considers using payroll deductions to finance the health care needs of all formal sector employees while financing the health care of the rest of the population using tax revenues. It is also recommeded that the NHIS considers making the payment of insurance premium flexible, such as allowing housholds to pay in installments or in kind.