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Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana

BACKGROUND: Utilization of healthcare in Ghana’s novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme’s financial sustainability. This paper investigates the presence of adverse selection by assessing the effect...

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Autores principales: Duku, Stephen Kwasi Opoku, Asenso-Boadi, Francis, Nketiah-Amponsah, Edward, Arhinful, Daniel Kojo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021654/
https://www.ncbi.nlm.nih.gov/pubmed/27624462
http://dx.doi.org/10.1186/s13561-016-0122-6
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author Duku, Stephen Kwasi Opoku
Asenso-Boadi, Francis
Nketiah-Amponsah, Edward
Arhinful, Daniel Kojo
author_facet Duku, Stephen Kwasi Opoku
Asenso-Boadi, Francis
Nketiah-Amponsah, Edward
Arhinful, Daniel Kojo
author_sort Duku, Stephen Kwasi Opoku
collection PubMed
description BACKGROUND: Utilization of healthcare in Ghana’s novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme’s financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal. METHOD: Routine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was performed to test if the proportion of insured who utilize healthcare in a particular year and renew membership the following year is significantly different from those who utilize healthcare and drop-out. Logistic regressions were estimated to examine the relationship between healthcare utilization and frequency of use in previous year and NHIS renewal in current year. RESULTS: We found evidence suggestive of the presence of adverse selection in the NHIS. Majority of insured who utilized healthcare renewed their membership whiles most of those who did not utilize healthcare dropped out. The likelihood of renewal was significantly higher for those who utilize healthcare than those who did not and also higher for those who make more health facility visits. CONCLUSION: The NHIS claims bill is high because high risk individuals who self-select into the scheme makes more health facility visits and creates financial sustainability problems. Policy makers should adopt pragmatic ways of enforcing mandatory enrolment so that low risk individuals remain enrolled; and sustainable ways of increasing revenue whiles ensuring that the societal objectives of the scheme are not compromised.
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spelling pubmed-50216542016-09-29 Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana Duku, Stephen Kwasi Opoku Asenso-Boadi, Francis Nketiah-Amponsah, Edward Arhinful, Daniel Kojo Health Econ Rev Research BACKGROUND: Utilization of healthcare in Ghana’s novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme’s financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal. METHOD: Routine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was performed to test if the proportion of insured who utilize healthcare in a particular year and renew membership the following year is significantly different from those who utilize healthcare and drop-out. Logistic regressions were estimated to examine the relationship between healthcare utilization and frequency of use in previous year and NHIS renewal in current year. RESULTS: We found evidence suggestive of the presence of adverse selection in the NHIS. Majority of insured who utilized healthcare renewed their membership whiles most of those who did not utilize healthcare dropped out. The likelihood of renewal was significantly higher for those who utilize healthcare than those who did not and also higher for those who make more health facility visits. CONCLUSION: The NHIS claims bill is high because high risk individuals who self-select into the scheme makes more health facility visits and creates financial sustainability problems. Policy makers should adopt pragmatic ways of enforcing mandatory enrolment so that low risk individuals remain enrolled; and sustainable ways of increasing revenue whiles ensuring that the societal objectives of the scheme are not compromised. Springer Berlin Heidelberg 2016-09-13 /pmc/articles/PMC5021654/ /pubmed/27624462 http://dx.doi.org/10.1186/s13561-016-0122-6 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.
spellingShingle Research
Duku, Stephen Kwasi Opoku
Asenso-Boadi, Francis
Nketiah-Amponsah, Edward
Arhinful, Daniel Kojo
Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana
title Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana
title_full Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana
title_fullStr Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana
title_full_unstemmed Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana
title_short Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana
title_sort utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in ghana
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5021654/
https://www.ncbi.nlm.nih.gov/pubmed/27624462
http://dx.doi.org/10.1186/s13561-016-0122-6
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