Enrolment in and Utilisation of National Health Insurance Scheme (NHIS) Services in Ghana : Perspective of Clients, Healthcare Providers, and NHIS Managers.

Abstract

This study explored the factors that affect enrollment in and utilisation of NHIS services in Ghana within the context of social health insurance. Ghana became the first country in sub-Saharan Africa to implement a social health insurance scheme shortly after a health insurance bill was presented to Ghana’s parliament in June 2003 (Amu et al., 2018). The National Health Insurance Scheme (NHIS) is funded with 70 percent indirect taxes (2.5% from goods and services), 20-25 percent from social security contributions from workers, and about 5 percent from development partners and annual premium contributions from beneficiaries of the scheme. NHIS enrollment statistics between 2013 and 2016 revealed that new enrolment grew by only 1% between 2013 and 2014 then followed by a reduction of 28% between 2015 and 2016. Reduced enrollment in the NHIS limits access to healthcare and offsets financial protection in times of sickness, especially among deprived folk. This study aims to provide a more comprehensive assessment for an in-depth understanding of the factors that influence NHIS enrollment and subsequent utilization of services from the perspective of healthcare providers, NHIS clients, and Managers, as opposed to previous studies which were largely NHIS-beneficiary-based. Using an exploratory case study, I collected qualitative data using semi-structured interview guide among NHIS beneficiaries and non-beneficiaries, managers and healthcare providers to be able to comprehensively ascertain specific barriers and influencers that affect enrollment in the NHIS. The findings of this study from the qualitative analysis with Dovetail showed that most respondents, especially women enrolled in the national health insurance scheme, as a result of pregnancy, which clearly outlined the extra need to be risk averse in the state of pregnancy, since this predisposes them to additional physical, physiological, and psychosocial risks. The predominant driving factor among males on the contrary was to offer financial protection. The absence of some services deemed to be covered by the national health insurance scheme at the point of healthcare access and delivery, For example, the absence of prescription drugs and total or partial out-of-pocket payments for same, laboratory tests, and medical investigations, as well as other medical and surgical interventions was a major factor that prevented some clients from premium renewals.