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Research
Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana
  1. Nele van der Wielen1,
  2. Andrew Amos Channon2,
  3. Jane Falkingham2,3
  1. 1 Centre for Research on Ageing, University of Southampton, Southampton, UK
  2. 2 Department of Social Statistics and Demography Social Sciences, University of Southampton, Southampton, UK
  3. 3 Centre for Population Change, University of Southampton, Southampton, UK
  1. Correspondence to Dr Nele van der Wielen; n.van-der-wielen{at}soton.ac.uk

Abstract

Introduction This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed.

Methods Using the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over.

Results The raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled.

Conclusion The results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.

  • health insurance
  • public health
  • health policy
  • health systems evaluation
  • health systems

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2017-000590

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    Footnotes

    • Handling editor Sanni Yaya

    • Contributors All authors have made a significant contribution to this paper. All authors have been involved in planning, drafting, writing and revising the paper. NvdW conducted the main analysis. AAC and JF were heavily involved in the interpretation of the data. All authors have given approval for this version of the paper to be published. All authors are accountable for the work in this paper.

    • Funding This work was supported by Economic and Social Research Council (ESRC) grant number ES/J500161/1.

    • Competing interests None declared.

    • Ethics approval University of Southampton.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The dataset analysed during the current study is available from the Ghana Statistical Service National Data Archive (http://www.statsghana.gov.gh/nada/index.php/home).