Factors Influencing Enrolment Into The National Health Insurance Scheme: A Case Study Of Lower Manya-krobo Municipality - Eastern Region, Ghana

Abstract

Background: Health care financing is one of the major and pressing issues challenging the healthcare delivery sector in Ghana. Right after attaining independence, the country embraced the socialist philosophy, where the then government made healthcare services completely free, as was the case with education and other social intervention programs. However, not too long into the era, Ghanaians were made to pay out-of-pocket when receiving healthcare services in the famous “Cash-and-Carry” delivery system. Since 2003, the country introduced the National Health Insurance Scheme as a means to lessen the burden on the healthcare expenditure of the people. However, over 16 years of its implementation, there is still the problem of enrolment and retention. This study aimed at determining the factors influencing enrolment into the National Health Insurance Scheme in the Lower Manya Krobo Municipality of the Eastern Region in Ghana. Methods: The study employed a cross-sectional study design with a quantitative approach to determine the factoring influencing NHIS enrolment in the Lower Manya Krobo Municipality. The total sample size was 362, with data obtained through questionnaire administration. Univariate, bivariate, and multivariate analyses were conducted to respectively estimate frequencies, measure the level of associations, and predict outcomes on selected variables outputs. A p-value <0.05 was considered as significant level with 95% CI. Results: Almost all the respondents (98.1%) have heard about the Ghana Health Insurance Scheme. Major sources of such information were from Radio and Television, and family or relatives. NHIS enrollment stood at 69.1%, and factors such as age (p = 0.033), sex (p<0.001), educational level (p <0.001), and income status (p <0.05) were significantly associated with enrolment. Again, 90% had expressed their intentions to renew membership. Indicators such as reported educational level, marital status, and income were also concomitant with respondents’ intentions to renew membership. Conclusion: Although NHIS enrolment in the study region was higher than the national average, there were still over 30% of the respondents who have never enrolled. More efforts are needed to achieve total enrolment by all given that was the policy directive guiding the scheme.