Refusal to enrol in Ghana's National Health Insurance Scheme: is affordability the problem?
Refusal to enrol in Ghana's National Health Insurance Scheme: is affordability the problem?
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DOI：
10.1186/s12939-014-0130-2
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发表时间：
2015-01-17
影响因子：
4.8
通讯作者：
Asante FA
中科院分区：
文献类型：
--
作者：
Kusi A;Enemark U;Hansen KS;Asante FA
获得医疗保险预计将对改善获得医疗保健的机会产生积极影响，并为家庭提供财务风险保护。加纳于2004年开始实施国家健康保险计划，以确保所有居民公平获得基本保健。经过十年的实施，全国覆盖率仅为全国人口的34%左右。家庭往往将国家医疗保险缴款的负担能力作为加入国家医疗保险的主要障碍，而没有对这种说法进行任何严格的分析。鉴于全球对实现全民健康保险的兴趣，本研究旨在审查国家医疗保险缴款的负担能力在多大程度上成为家庭全面保险的障碍和家庭资源的负担。这项研究使用了2011年1月至4月期间进行的一项横断面家庭调查的数据，该调查涉及加纳三个地区的2,430个家庭。根据负担能力的规范定义，采用基于家庭负担能力的方法分析了国家医疗保险缴款的负担能力。通过将国家医疗保险的预期年度缴款与家庭非食品支出和总消费支出相联系，评估了国家医疗保险对家庭的缴款负担。确定了无法负担全额保险的家庭。结果表明，66%的未投保家庭和70%的部分投保家庭能够为其成员提供全额保险。将所有家庭成员纳入国家医疗保险将占家庭非食品支出的5.9%或总支出的2.0%，但在社会经济五等分层第一层（11.4%）和第二层（7.0%）的家庭中比例更高。所有被确定为无法负担全部保险的家庭（29%）都属于社会经济地位较低的五分之二，而且家庭人口众多。与保险人属性有关的非财务因素和卫生系统问题也影响到加入国家医疗保险。对于社会经济地位低和家庭人口多的家庭来说，全额保险的负担能力将是一个负担。需要采取创新措施，鼓励有能力的家庭入学。政策应旨在取消儿童登记费，根据家庭的社会经济状况确定保险价格，并解决不利的非财务因素，以增加国家医疗保险的覆盖面。
Access to health insurance is expected to have positive effect in improving access to healthcare and offer financial risk protection to households. Ghana began the implementation of a National Health Insurance Scheme (NHIS) in 2004 as a way to ensure equitable access to basic healthcare for all residents. After a decade of its implementation, national coverage is just about 34% of the national population. Affordability of the NHIS contribution is often cited by households as a major barrier to enrolment in the NHIS without any rigorous analysis of this claim. In light of the global interest in achieving universal health insurance coverage, this study seeks to examine the extent to which affordability of the NHIS contribution is a barrier to full insurance for households and a burden on their resources. The study uses data from a cross-sectional household survey involving 2,430 households from three districts in Ghana conducted between January-April, 2011. Affordability of the NHIS contribution is analysed using the household budget-based approach based on the normative definition of affordability. The burden of the NHIS contributions to households is assessed by relating the expected annual NHIS contribution to household non-food expenditure and total consumption expenditure. Households which cannot afford full insurance were identified. Results show that 66% of uninsured households and 70% of partially insured households could afford full insurance for their members. Enroling all household members in the NHIS would account for 5.9% of household non-food expenditure or 2.0% of total expenditure but higher for households in the first (11.4%) and second (7.0%) socio-economic quintiles. All the households (29%) identified as unable to afford full insurance were in the two lower socio-economic quintiles and had large household sizes. Non-financial factors relating to attributes of the insurer and health system problems also affect enrolment in the NHIS. Affordability of full insurance would be a burden on households with low socio-economic status and large household size. Innovative measures are needed to encourage abled households to enrol. Policy should aim at abolishing the registration fee for children, pricing insurance according to socio-economic status of households and addressing the inimical non-financial factors to increase NHIS coverage.
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影响因子：
3.5
作者：
Bundorf, M. Kate;Pauly, Mark V.
通讯作者：
Pauly, Mark V.
影响因子：
5.4
作者：
De Allegri, M;Sanon, M;Sauerborn, R
通讯作者：
Sauerborn, R
影响因子：
3.3
作者：
Dong, Hengjin;De Allegri, Manuela;Sauerborn, Rainer
通讯作者：
Sauerborn, Rainer
影响因子：
3.2
作者：
Chankova S;Sulzbach S;Diop F
通讯作者：
Diop F
影响因子：
3.2
作者：
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通讯作者：
van der Geest, Sjaak