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Elizabeth Nardi September 11, 2014

Knowledge and Perceptions of the National Health Insurance Scheme in Ghana: Who is renewing enrollment, who is not, and why?. Elizabeth Nardi September 11, 2014. 2. Research Questions. 3. Methods. 4. Data. 5. Approach. Contents. 2. Research Questions. 3. Methods. 4. Data. 5. Approach.

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Elizabeth Nardi September 11, 2014

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  1. Knowledge and Perceptions of the National Health InsuranceScheme in Ghana: Who is renewing enrollment, who is not, and why? Elizabeth NardiSeptember 11, 2014

  2. 2. Research Questions 3. Methods 4. Data 5. Approach Contents

  3. 2. Research Questions 3. Methods 4. Data 5. Approach Contents

  4. The National Health Insurance Scheme • 2003 • Initiative by Government to: • alleviate the impact of user fees (cash and carry) • secure financial risk protection against the cost of healthcare services for all residents • promote equity and universal coverage to health services

  5. Various Sources of Funding

  6. Exemption Policy • 6 month waiting period • Annual renewal

  7. Achievements Challenges • 1.3 million (2005)  8.9 million (2012) • Establishment of 145 autonomous schemes • Benefit package covers 95% of disease burden • Claims processing, administrative delays • Enrollment of informal workers (non-exempt) • Regressive premiums1 • 65% cash and carry2 • Renewal

  8. Past Studies on Renewal • “for every 100 people that registered with the NHIS over the past decade, more than 50 people have chosen to, or have not been able to, renew their cards” • “if informal workers are not renewing and paying their premiums, the NHIF may suffer from lack of funding from premiums and put a strain on the system”

  9. Past Studies on Renewal • “dissatisfied insured members that perceive those making out-of-pocket payments as receiving shorter wait times and higher quality of care “ • “respondents in the lower 20% income group identified high premium charges as the main reason for not renewing, while those in the upper income group cited both long waiting period and high premium as the main reasons for non-renewal”

  10. 2. Research Questions 3. Methods 4. Data 5. Approach Contents 1. Background

  11. This study aims to answer: • What is the trend of membership enrollment and renewal in the National Health Insurance Scheme? • What are the differences between groups that renew their insurance membership compared to those that do not renew? • What are the knowledge and perceptions of the health system and National Health Insurance Scheme that affect membership renewal?

  12. 2. Research Questions 3. Methods 4. Data 5. Approach Contents 1. Background

  13. Conceptual Framework Source: C. Jehu-Appiah et al. 2011

  14. Methodology • Three phases • Secondary data sources: • Socio-Economic Standards Questionnaire • Health Insurance Form 2011 • Sample population: • 4,849 renewed • 6,391 not renewed • 450 renewed households • Study location: • ShaiOsudoku district • NingoPrampram district

  15. Phase I – Enrollment Trend • SES Questionnaire from 2006-2013 • Registered members, not active members

  16. Phase II • Background information for phase III • Health Insurance Form 2011 • Those who responded that they renewed, those that responded no renewal • Descriptive summary statistics from SES questionnaire

  17. Phase III – Quantitative Methods • 450 registered households that renewed in 2011 • Head of household or member over 18 • Questionnaire • Demographics • Household characteristics • Include questions on exemption status of household members • Renewal in 2012, 2013, 2014 • Attitudes and perceptions of NHIS and health care services

  18. Is the premium affordable for you? • In your opinion, do NHIS card holders get better/same/ worse service than others? • What would make you more likely to renew/continue renewing your health insurance? Yes No Better Same Worse Lower premium Shorter wait times Automatic enrollment

  19. Projected Timeline

  20. 2. Research Questions 3. Methods 4. Data 5. Approach Contents 1. Background

  21. Data • STATA version 13 • Renewal trend since 2011 • Descriptive summary statistics from 2013 • Cross-sectional snapshot • Multivariate logistic regression • Dependent variable: insurance renewal • Factors that affect renewal

  22. 2. Research Questions 3. Methods 4. Data 5. Approach Contents 1. Background

  23. Limitations • Restricted regional focus and sample population • Less generalizability • Recall bias • Loss of respondents to follow up • Omitted variable bias

  24. Thank you!

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