Abstract:
Background: In Ghana, the National Health Insurance Scheme (NHIS) was established in
2003 to bridge the gap in the unequal distribution of health services to achieve universal health
coverage. Despite some successes of the scheme, there is evidence that individuals enrolled in
the NHIS still encounter out-of-pocket health expenditure (OOPHE).
General Aim: This study sought to investigate out-of-pocket health care expenses under the
National Health Insurance Scheme (NHIS) in Ghana.
Methodology: This study used nationally representative household data from the 2022 Ghana
Demographic and Health Survey (GDHS). The study analysed the GHDS, focusing on outcome
variables such as out-of-pocket payment for drugs and services, family planning, laboratory
investigations, etc. A multi-stage stratified cluster design was used in DHS, based on a list of
enumeration areas (EAs), which are systematically selected units from localities and constitute
the local government areas (LGAs).
Results: About two-fourths of Ghanaians have ever enrolled in the NHIS (79%), but only
32.8% had an active coverage during the survey. Among those with active NHIS, about 6%
used health services within the past six months. Out of pocket payments were mainly for
consultations (20%), laboratories test (40%) and medications (30%). The study found that
82.3% of NHIS-enrolled individuals in Ghana face significant out-of-pocket healthcare
expenses despite insurance coverage.
Conclusion: The study concludes that the NHIS, while a step towards financial protection, has
gaps such as exclusion of some drugs and enrolment barriers that need addressing to ensure
equitable access to healthcare for all Ghanaians. Government must enhance NHIS coverage,
improving service quality, and implementing additional financial protection measures to
alleviate the burden on vulnerable populations.
