Spatial analysis of factors associated with household subscription to the National Health Insurance Scheme in rural Ghana


Submitted: 26 June 2013
Accepted: 6 November 2013
Published: 4 February 2014
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Authors

  • Stephen Manortey Department of Family and Preventive Medicine, University of Utah, Salt Lake City, United States.
  • James VanDerslice Department of Family and Preventive Medicine, University of Utah, Salt Lake City, United States.
  • Steve Alder Department of Family and Preventive Medicine, University of Utah, Salt Lake City, United States.
  • Kevin A. Henry Department of Epidemiology, Rutgers School of Public Health, Piscataway, United States.
  • Benjamin Crookston Department of Health Sciences, Brigham Young University, Provo, United States.
  • Ty Dickerson Department of Pediatrics, University of Utah, Salt Lake City, United States.
  • Scott Benson Department of Family and Preventive Medicine, University of Utah, Salt Lake City, United States.
The use of health insurance schemes in financing healthcare delivery and to minimize the poverty gap is gaining considerable recognition among the least developed and resource challenged countries around the world. With the implementation of the socialized health insurance scheme, Ghana has taken the lead in Sub-Saharan Africa and now working out further strategies to gain universal coverage among her citizenry. The primary goal of this study is to explore the spatial relationship between the residential homes and demographic features of the people in the Barekese subdistrict in Ghana on the probability to enroll the entire household unit in the National Health Insurance Scheme (NHIS). Household level data were gathered from 20 communities on the enrollment status into the NHIS alongside demographic and socioeconomic indicators and the spatial location of every household that participated in the study. Kulldorff’s purely spatial scan statistic was used to detect geographic clusters of areas with participatory households that have either higher or lower enrollment patterns in the insurance program. Logistic regression models on selected demographic and socioeconomic indicators were built to predict the effect on the odds of enrolling an entire household membership in the NHIS. Three clusters significantly stood out to have either high or low enrollment patterns in the health insurance program taking into accounts the number of households in those sub-zones of the study region. Households in the Cluster 1 insurance group have very high travel expenses compared to their counterparts in the other idenfied clusters. Travel cost and time to the NHIS registration center to enroll in the program were both significant predictors to participation in the program when controlling for cluster effect. Residents in the High socioeconomic group have about 1.66 [95% CI: 1.27-2.17] times the odds to enroll complete households in the insurance program compared to their counterparts in the Low socioeconomic group. The study demonstrated the use of spatial analytical tools to identify clusters of household enrollment pattern in the NHIS among residents in rural Ghana. In the face of limited resources, policy makers can therefore use the findings as guideline to strategically channel interventions to areas of most need. Furthermore, these analyses can be repeated annually to assess progress on improving insurance coverage.

Manortey, S., VanDerslice, J., Alder, S., Henry, K. A., Crookston, B., Dickerson, T., & Benson, S. (2014). Spatial analysis of factors associated with household subscription to the National Health Insurance Scheme in rural Ghana. Journal of Public Health in Africa, 5(1). https://doi.org/10.4081/jphia.2014.353

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