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Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme

BACKGROUND: Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health ins...

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Autores principales: Aryeetey, Genevieve Cecilia, Westeneng, Judith, Spaan, Ernst, Jehu-Appiah, Caroline, Agyepong, Irene Akua, Baltussen, Rob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957846/
https://www.ncbi.nlm.nih.gov/pubmed/27449349
http://dx.doi.org/10.1186/s12939-016-0401-1
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author Aryeetey, Genevieve Cecilia
Westeneng, Judith
Spaan, Ernst
Jehu-Appiah, Caroline
Agyepong, Irene Akua
Baltussen, Rob
author_facet Aryeetey, Genevieve Cecilia
Westeneng, Judith
Spaan, Ernst
Jehu-Appiah, Caroline
Agyepong, Irene Akua
Baltussen, Rob
author_sort Aryeetey, Genevieve Cecilia
collection PubMed
description BACKGROUND: Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty. METHODS: We conducted two repeated household surveys in two regions of Ghana in 2009 and 2011. We first analyzed the effect of OOPE on poverty by estimating poverty headcount before and after OOPE were incurred. We also employed probit models and use of instrumental variables to analyze the effect of health insurance on OOPE, CE and poverty. RESULTS: Our findings showed that between 7–18 % of insured households incurred CE as a result of OOPE whereas this was between 29–36 % for uninsured households. In addition, between 3–5 % of both insured and uninsured households fell into poverty due to OOPE. Our regression analyses revealed that health insurance enrolment reduced OOPE by 86 % and protected households against CE and poverty by 3.0 % and 7.5 % respectively. CONCLUSION: This study provides evidence that high OOPE leads to CE and poverty in Ghana but enrolment into the NHIS reduces OOPE, provides financial protection against CE and reduces poverty. These findings support the pro-poor policy objective of Ghana’s National Health Insurance Scheme and holds relevance to other low and middle income countries implementing or aiming to implement insurance schemes.
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spelling pubmed-49578462016-07-23 Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme Aryeetey, Genevieve Cecilia Westeneng, Judith Spaan, Ernst Jehu-Appiah, Caroline Agyepong, Irene Akua Baltussen, Rob Int J Equity Health Research BACKGROUND: Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty. METHODS: We conducted two repeated household surveys in two regions of Ghana in 2009 and 2011. We first analyzed the effect of OOPE on poverty by estimating poverty headcount before and after OOPE were incurred. We also employed probit models and use of instrumental variables to analyze the effect of health insurance on OOPE, CE and poverty. RESULTS: Our findings showed that between 7–18 % of insured households incurred CE as a result of OOPE whereas this was between 29–36 % for uninsured households. In addition, between 3–5 % of both insured and uninsured households fell into poverty due to OOPE. Our regression analyses revealed that health insurance enrolment reduced OOPE by 86 % and protected households against CE and poverty by 3.0 % and 7.5 % respectively. CONCLUSION: This study provides evidence that high OOPE leads to CE and poverty in Ghana but enrolment into the NHIS reduces OOPE, provides financial protection against CE and reduces poverty. These findings support the pro-poor policy objective of Ghana’s National Health Insurance Scheme and holds relevance to other low and middle income countries implementing or aiming to implement insurance schemes. BioMed Central 2016-07-22 /pmc/articles/PMC4957846/ /pubmed/27449349 http://dx.doi.org/10.1186/s12939-016-0401-1 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Aryeetey, Genevieve Cecilia
Westeneng, Judith
Spaan, Ernst
Jehu-Appiah, Caroline
Agyepong, Irene Akua
Baltussen, Rob
Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme
title Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme
title_full Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme
title_fullStr Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme
title_full_unstemmed Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme
title_short Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme
title_sort can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? evidence from ghana’s national health insurance scheme
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957846/
https://www.ncbi.nlm.nih.gov/pubmed/27449349
http://dx.doi.org/10.1186/s12939-016-0401-1
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