The Influence of Knowledge on National Health Insurance Scheme (NHIS) Service and Enrollment in Ghana

Abstract

Background: As part of Ghana’s initiatives to bridge the gap in the uneven distribution of healthcare resources and health services to achieve universal health coverage, the National Health Insurance Authority, through its Act 852, provides the gateway for the implementation of access to equitable healthcare for citizens through affordable means. Evidence shows that despite increases in population coverage of the scheme and utilization of healthcare services, enrollment into the scheme has stagnated over the years since its inception. General Aim: This study seeks to examine the influence of the knowledge of the scheme’s services and enrollment among household heads in Ghana. Methodology: This research used a cross-sectional study based on secondary data from the Ghana Living Standards Survey Round Seven of household heads that was held over a span of 12 months between October 2016 and October 2017 with a total sample size of 5722 through a quantitative method. A descriptive analysis was carried out to obtain summary tables from sociodemographic factors and information on the insurance scheme status of study participants using Microsoft Excel. Data was analyzed using STATA Version 17.0 to test the relationship between the explanatory variable, knowledge of NHIS services and enrollment in the NHIS, the outcome variable. Bivariate analysis and multivariate logistic regression were conducted. Prior to the running of the logistic regression, the bivariate analysis was conducted using a chi-squared test to examine the significant association among the socio-demographic features and NHIS enrollment. The logistic regression was used to analyze the associations between knowledge and enrollment and all other significant variables, namely age-group, education level, geographic region and marital status (p<0.05). Findings: About a third of the respondents (62%) had poor knowledge of the health insurance scheme benefits irrespective of their enrollment status. Enrollment in the scheme was captured at 65% and factors like the level of knowledge (p<0.001), level of education (p=0.033) and geographic regions (p<0.001) were significantly associated with enrollment. Conclusion: As knowledge plays a significant role in national health insurance scheme enrollment, there is a need for governmental bodies like the Ministry of Health and Education to consistently continue the promotion and education of the range of health service scheme benefits citizens are entitled to benefit from at interval points to boost enrollment across the nation and help fast-track the goal of universal health coverage in Ghana. Community members should also be factored in and involved in the communication strategy to ensure that communication is effective as it respects the norms and beliefs of society, making it easier to reach the masses.