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";s:4:"text";s:36984:"A second limitation is related to the assumption that women’s enrollment status at the date of the interview is representative for their status during their pregnancy in the last two years. The new system included the accreditation of providers, agreement on contribution rates with the schemes, management of the National Health Insurance Fund and approval of cards for membership. In 2008 two relevant changes were introduced: a free maternity care policy with the specific goal to improve access to maternal care [19] and the Ghana-Diagnosis Related Groups (G-DRGs) for cost containment [20]. https://doi.org/10.1371/journal.pone.0165623, Editor: Osman Alimamy Sankoh, INDEPTH Network, GHANA, Received: November 5, 2015; Accepted: October 15, 2016; Published: November 11, 2016. First, health insurance may lead to better health, therefore cushioning households against the risk of health shocks which might diminish the capacity of households to generate income [2]. Save my name, email, and website in this browser for the next time I comment. After almost a decade of implementation, this study aims to investigate the association of NHIS membership with antenatal visits (ANC), postnatal visits (PNC) and under-five mortality, using data from the most recent Multiple . To overcome this problem, a two stage model is typically employed: in the first stage, an estimate of the determinants of the likelihood of out-of-pocket encounter provides information at the extensive margin; in the second stage, an estimate of the determinants of utilization conditional on a positive health expenditure provides information at the intensive margin (see [4, 21] for examples applied to health). In: Culyer AJ, Newhouse JP, editors. NATIONAL HEALTH INSURANCE MANAGEMENT AUTHORITY NOTICE. This has perceptively resulted in an increase in out-patient attendance at all facilities especially CHPS facilities. The national health insurance scheme (NHIS) was established under Act 650 of 2003 by the Government of Ghana to provide essential health care services to persons' resident in the country through district mutual health insurance scheme (DMHIS) and private health insurance schemes. This review explores the context under which private voluntary health insurance could contribute to an improvement in the sustainability of the health sector and financial protection in other countries. In Ghana, the National Health Insurance Scheme (NHIS) was initiated as a major tool to eliminate barriers in accessing healthcare services. To investigate how the National Health Insurance Schemes (NHIS) in Ghana affects the utilization of maternal health care services and medical out-of-pocket expenses. No, Is the Subject Area "Ghana" applicable to this article? Adverse selection should be muted by the required waiting period of a maximum of six months [40], usually three months [27] after enrollment. Cutler DM, Zeckhauser RJ. Table S6. No, Is the Subject Area "Finance" applicable to this article? Using cross sectional data for propensity score matching (PSM) Blanchet et al. Under this expansion of health services, increased access to and use of preventive and curative care for both acute and chronic illnesses is expected . 2006;63:1236–45. Health Care Providers. What happens if you drink 3 monsters in a day? Given that enrollment rates were highest in the latter two regions at the time of these studies [7], the findings from these two areas are not necessarily representative for other parts of Ghana. Xu K, Evans D, Kawabata K, Zeramdini R, Klavus J, Murray C. Household catastrophic health expenditure: a multicountry analysis. Urban residents are more likely than rural residents to be covered by the NHIS. Furthermore, the new NHIS law, Act 852 (2012), has been enacted with the aims to consolidate the health insurance system, improving the government and the utilization of the schemes. National Health Insurance Scheme (NHIS) is a strategy by the government for reducing maternal, morbidity and mortality rate because adequate utilization of the health care scheme is associated with improved health outcomes. Hon. We analyze these data at the level of the child and have information about every pregnancy preceding the birth of that specific child for the period 2006–2008. In the mid 1990s, a unit was created in the Ministry of Health (MOH) to establish national health insurance as an alternative to 'cash and carry'. The analysis of the results obtained from the first step of the bivariate probit regressions deserve a particular attention since it provides useful insights about the determinants of the NHIS enrollment. Int J Equity Health. Regarding the NHIS enrollment, 62 % of women and 48.5 % of men are covered by the NHIS, compared with 0.4 % of women and 1.21 of men, who have health insurance provided by their employer. These results are in line with previous finding in the literature on the determinants of the health insurance enrollment [27–29]. The outcome “child fully vaccinated” was 1 if five relevant vaccinations (see below) were provided and 0 otherwise. In this section we focus our attention on the introduction, organization and functioning of the NHIS. Table S3. Health Economics Review With the introduction of the National Health Insurance Scheme (NHIS), which is a form of Health care financing in order to serve as a conduit for providing financial access to health care. The results from the first step of these regressions (see Additional file 1: Table S7) show that the scheme is successfully capturing Moslem women (with regard to traditional/spiritualist or no religion) and women with a higher educational background. During our study period, the early years of the NHIS, delivery care was part of the benefit package. This study uses the “Births Recode” data which are provided in STATA, ASCII, SAS and SPSS format. For consistency reasons we use the same decision-to-enroll model as applied for the full sample. Moreover, the result for the variable “population per doctor” suggests that the scarcity of public health care service may disincentive the enrollment in the scheme. The results obtained from the bivariate probit regressions confirm those from probit regressions, with the exception of the results for out-of-pocket expenses. This paper focuses on the experience of Ghana, where a National Health Insurance Scheme (NHIS) was fully implemented by the end of 2004 [7–10]. Finally, our findings indicate that the availability of government health facilities in a region is associated with higher likelihood of enrollment in the NHIS. This review is to describe polices and interventions of cost sharing in health insurance schemes; and to describe how the authors have assessed effects of cost sharing methods in health insurance schemes where available. National Health Insurance Scheme in Nigeria (Prospects and Problems)…. This is typical of premiums paid for health insurance schemes. The age of the child’s mother, marital status, ethnicity, education, occupation, wealth and region of residence are important predictors of the decision to enroll in the NHIS. Article  Yet while this expansion of coverage will almost inevitably have improved access to health care, however, it cannot be assumed that it will . The anatomy of health insurance. Of the 1,433 births examined, 1,355 (94.6%) were live births, and 78 (5.4%) were still-births. The prevalence of LBW among cash and carry infants is 23.2%. This is significantly higher than among NHIS infants - 16.8%. Affiliations Contact Details. Surprisingly, the level of household wealth does not affect health insurance coverage. [17] and Mensah et al. Nigeria is eager to achieve UHC. Informal sector workers were charged premiums that should be income related. Differences in antenatal care coverage by women’s age at birth are not large; however, there are some differences by birth order. By using this website, you agree to our In this table only the marginal effect of the variable “NHIS Enrollment” is shown. The bill imposed a national health insurance levy on members of the scheme in order to finance the scheme. That was the first mistake. We analyzed the 2014 GDHS focusing on four outcome variables, i.e. Several committee have been set up to unravel the mystery but they come up short. We also found a significantly lower rate of pregnancies reported as too soon or unwanted among the insured, even though family planning services are not covered by the NHIS. No, Is the Subject Area "Vitamin A" applicable to this article? Ghana's National Health Insurance Scheme (NHIS) was introduced in 2005 as a demand side intervention to remove financial barriers to accessing health services. This study aims to examine the impact of selected socioeconomic, demographic, health, health-related characteristics on the demand for private health insurance in Malaysia. Abuse by all players in the industry; NHIS itself, HMOs, Health care facilities and enrollees. We study eight main outcomes: at least 4 antenatal care (ANC) visits, at least 4 ANC visits with a skilled provider (doctor, nurse/midwife, auxiliary midwife or community nurse), delivery assisted by a skilled provider, delivery assisted by a skilled provider in a public facility, caesarean section, pregnancy too soon or unwanted (occurred earlier than desired or when no or no more children were desired), child received vitamin A and child fully vaccinated (see Table 1). They want to obtain expensive antibiotics to re-sell or you see non hypertensive patients obtaining anti-hypertensive drugs to their sick parents or in-laws. A detailed description of these algorithms can be found in Khandker et al. Table S7. After a short registration process (https://dhsprogram.com/data/new-user-registration.cfm) the data can be accessed (http://dhsprogram.com/data/dataset/Ghana_Standard-DHS_2008.cfm?flag=0). To study the effects of NHIS enrollment among lower socio-economic groups, we estimated the effects among the children from poor households (for sample sizes see Table 1). With regard to ethnicity, the Akan is the largest ethnic group followed by the Mole Dagbani and the Ewe. Both studies found no effect on polio vaccinations. Eur J Econ Finance Admin Sci. In the following step of our analysis, we use this logit model as the principal mean to construct a balanced sample of NHIS members and comparable non NHIS members. 36-6th Avenue, Opposite AU Suite, Ridge Residential Area, Accra. The NHIS law, Act 650 of the Parliament of the Republic of Ghana, was passed in September 2003. Mensah et al. Access to and use of health services are concerns in poor countries. I am a practicing medical doctor, a philosopher, critical thinker, a globalist, a patriot, SEO expert and a patient blogger. Prior to the implementation of the NHIS, in 2003, the Ghanaian government introduced a delivery fee exemption policy using a stepwise geographical roll-out leading to theoretical nationwide coverage in April 2005, i.e. Uninsured households, on the other hand, need to devote a larger part of their budget to resolve health problems, i.e., spending on healthcare, which diverts resources from the consumption of other goods [5, 6]. On the contrary, in the regressions for out-of-pocket expenses the marginal effect of the NHIS enrollment is not significant anymore. Health, Health Insurance and the Labor Market. Thus, the policy strategy is to design a scheme that would guarantee coverage for all without Table 5 summarizes the results from bivariate probit estimates for all the outcome variables. We hypothesize to find no effect of the NHIS on infant vaccinations and use this outcome as a robustness measure to determine whether we indeed find no effect on this outcome. However, given unavailability of income measures, a constant premium of 3 US dollars is charged in most cases [4,28]. "Universal Health Coverage (UHC) refers the idea that all people should be able to use any health services they require without incurring financial hardship. family planning advice and services provided alongside maternal care. Part of Since 2005, a number of initiatives have been put in place to simultaneously address sustainability challenges, reach universal access to health care and improve efficiency and transparency of the health system. Caesarean sections increased with 6 pp (p = 0.000). This became necessary for posterity sake because in my opinion I believe the health insurance industry though might be the answer will crash in a few years. In particular, we find that being enrolled in the NHIS positively affects the probability of formal antenatal check-ups before delivery, the probability of delivery in an institution and the probability of being assisted during delivery by a trained person. Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. About one in ten are from the Western, Central, Eastern, Northern, Volta and Brong Ahafo regions. Health Systems 20/20 Project and Research and Development Division of the Ghana Health Service , 2009 An Evaluation of the Effects of the 'National Health Insurance Scheme in Ghana. 2006;90:2351–6. broad scope, and wide readership – a perfect fit for your research every time. The distribution of respondent by urban/rural residence shows that about 50 % of women and men live in urban areas. Abt Associates Inc., Berthesda, MD Google Scholar Other significant revisions in the Law include an expenditure cap of 10 % on non-core NHIS activities, a relevant family planning package and a board oversight committee for scheme operations, private health insurance schemes and fund management. Saleh K. The Health Sector in Ghana: a comprehensive assessment. 2010;19:503–17. Google ScholarÂ. We analyze the 2014 GDHS, which includes retrospective information on the pregnancies and births that took place in the five years preceding the survey. 2. In these and in the following regressions, we consider three specifications, whose results are reported in different columns. Some reasons for this are the cost of service, the distance to the health facility, and the quality of care. For Indonesia to achieve UC, systems' performance must be improved and key policy choices with respect to the configuration of the health financing system must be made. In these regressions we consider the most complete specification which includes also proxies of the supply side (population per health facility and population per doctor). The National Health Insurance Scheme (NHIS) grew out of an election promise made in 2000 by the incoming New Patriotic Party to remove financial barriers to the utilization of health care. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty. Comparing health care use between enrollees and non-enrollees can provide biased estimates of the effects of NHIS because it is likely that NHIS membership is driven by factors that also correlate with health and health care use. 2002;92:51–76. We run five specifications which include different exclusion restrictions: (1) frequency of watching television; (2) frequency of watching television and frequency of listening to radio; (3) frequency of watching television, frequency of listening to radio and frequency of reading newspapers; (4) a score obtained from a principal component analysis considering the variables included in model (2); (5) a score obtained from a principal component analysis considering the variables included in model (3). [6], make the same assumption but include births up to four years prior to the survey. However, it is well known in the literature that enrollment in health insurance plans is generally not random and it is driven by observable and unobservable variables which might also affect the utilization of health care [22, 23]. To our knowledge there were no nationwide, continuous initiatives before the implementation of the NHIS to provide free family planning services. The weights are determined by the inverse of the distance to the propensity score of the child. The effect of the National Health Insurance Scheme (NHIS) on health service delivery in mission facilities in Ghana: a retrospective study Genevieve Cecilia Aryeetey1, Justice Nonvignon1, Caroline Amissah2, Gilbert Buckle2 and Moses Aikins1* Abstract Background: In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) to . Mothers with no or only primary education have an 18 pp lower probability (p = 0.000) to enroll and those without occupation (7 pp, p = 0.045) or working in agriculture (10 pp, p = 0.000) are also less likely to enroll. Mensah J et al. poor against adverse effects arising from health crises. The validity of the PSM approach generally depends on two conditions: i) conditional independence and ii) sizeable common support or overlap in propensity scores across the treated and the matched control sample [36,38]. Terms and Conditions, Discover a faster, simpler path to publishing in a high-quality journal. Objectives The study aimed to understand the impact of integrating a fee waiver for the National Health Insurance Scheme (NHIS) with Ghana's Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer programme on health insurance enrolment. Through a principal component analysis, each asset was assigned a weight and then standardized in relation to a normal distribution. Second, access to health insurance is expected to reduce out-of-pocket health expenses [3, 4]. Women aged 20–24 and men aged 25–29 are the least likely to be covered by the NHIS. The authors declare that they have no competing interests. Witter S, Garshong B, Ridde V. An exploratory study of the policy process and early implementation of the free NHIS coverage for pregnant women in Ghana. The probability to enroll increases with household wealth. We used propensity score matching (PSM) to limit the potential bias arising from the self-selection into the NHIS. Background: In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) to minimize out-of-pocket expenditure at the point of use of service. Fourth, before the introduction of the NHIS there was some provision of free vaccinations by the Global Alliance for Vaccines and Immunization which might partly explain the limited effects we found. They believe once the catastrophe is averted, then money has been wasted. We use the routine “psmatch2” in the statistical software package STATA 13 by Leuven and Sianesi [35] to calculate the average treatment effect on the treated (ATT). Article  Access to more generous health insurance is hypothesized to affect households in several ways. It evaluates the impact of the country's National Health Insurance Scheme on . J Polit Econ. Looking at the Nigerian population, access to health insurance is denied to a certain category of people as a result of . The National Health Insurance Scheme (NHIS) is a body corporate established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost. The definitive questionnaires were first prepared in English; they were then translated into the major local languages, namely Akan, Ga, and Ewe. The latter is of particular importance given that the distributional impact of these schemes is one of the biggest knowledge gaps in the field [9]. Delivery in Health Facility - Probit Regressions. Legislative Instrument on National Health Insurance. Ministry of Health Ghana. The health sector will witness efficiency the scheme will eliminate corruption indiscipline, fraud and ensuring death reduction from, all health, this in variable will lead to an increase in Nigeria citizens due to in improving bur artic and depressed health care delivery system will on establishing National health insurance scheme will fined . 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. The major objectives of antenatal care are to identify and treat problems during pregnancy. (Ghanaweb.com-4th march 2010) Liu T, Chen C. An analysis of private health insurance purchasing decisions with national health insurance in Taiwan. Agyepong IA, Adjei S. Public social policy development and implementation: a case study of the Ghana National Health Insurance Scheme. Descriptive Statistics: Antenatal Care, Delivery Care and Out-of-Pocket Expenditure. We present simple descriptive statistics of the main background characteristics that will be used in the subsequent sections of the paper. However, they study a smaller set of outcomes, do not investigate differences in effects across the entire versus the poor population and use a different methodological approach. We examined studies reporting on schemes that meet all of the criteria below: 1. The other half of the funding comes from taxes. In the subsample of households selected for the male survey, 4,609 eligible men were identified and 4,388 were successfully interviewed, yielding a response rate of 95 %. Having verified that the balancing property is satisfied, we present the ATT of being insured on maternal and infant health care use. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. The National Health Insurance Scheme (NHIS) is an insurance policy enacted by government in the early years of 2000 to eradicate the "cash and carry" system and provide a better health care for all Ghanaians. We apply Kernel matching to match the children from insured mothers to comparable controls on the basis of their propensity scores. There is considerable interest in exploring the potential of health insurance to increase the access to, and the affordability of, health care in Africa. The benefit package is broad, covering more than 95 percent of conditions that afflict Ghanaians. All employers are also obliged to ensure that all their employees are registered under the NHIS. Mensah et al. Moreover, the availability of government health facilities in a region is associated with higher likelihood of enrollment in the NHIS. Washington, DC: World Bank; 2013. The National Health Insurance Scheme (NHIS) took off in the year 2005 and is a corporate body established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost through various prepayment systems. We limit our analysis to the most recent live birth, up to two years preceding the interview, to increase credibility of this assumption. Provided by the Springer Nature SharedIt content-sharing initiative. We use the GDHS 2008, a nationally representative household survey with individual data collected for 4916 women aged 15–49 [7]. Found insideGhana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The National Health Insurance Scheme (NHIS) grew out of an election promise made in 2000 by the incoming New Patriotic Party to remove financial barriers to the utilization of health care. here. Printbegrænsninger: Der kan printes 10 sider ad gangen og max. 40 sider pr. session. volume 6, Article number: 7 (2016) Mensah J, Oppong J, Schmidt CM. Indeed, their contributions were supposed to be defined according to income so that the lowest-income group pays a premium of 7.20 Ghanaian cedi (GH¢) or US$ 8, while those in the highest income group pay a premium of GH¢ 48.00 or US$ 53. However, since [13] do not control for economic characteristics such as wealth and occupation, and [14] do not take into account the issue of self selection into enrollment, the results are not fully comparable. 1809) with the view to improving financial access of Ghanaians, especially the poor and the vulnerable, to quality basic health care services and to This book is a study of the reforms of primary care in Europe as well as their impacts on the broader co-ordination mechanisms within European health care systems. Further, living in the Brong-Ahafo and the Upper East region is more common among those with insurance. https://doi.org/10.1371/journal.pone.0165623.g001. The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. 2010;19:95–106. All covariates used in this regression model are shown in Table 2. This seeks to set up a National Health . However, there was no difference in use of maternal care between women who are enrolled and women who are not. Source: 2014 Ghana DHS- Own elaboration. Bull World Health Organ. Health service utilisation, or accessibility to health services, were strongly affected by the existence of a chronic condition within the household; a regular situation arose in the health insurance scheme, known as adverse selection, where people who are prone to suffering from health problems are more likely to acquire health insurance . Information about whether a child received vitamin A and the relevant vaccinations was based on the information recorded on the vaccination card. Dr Aderibigbe Adedayo,a Clinical Epidemiologist, talks about the Challenges, problems and prospects of that National Health Insurance Scheme (NHIS) in Nigeria. Today, the NHI covers more than 98% of Taiwan's population and enrollees enjoy almost free access to healthcare with small co-payment by most clinics and hospitals. Health care facilities are the worst. Consumption smoothing and the welfare consequences of social insurance in developing economies. The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. Soc Sci Med. 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Implemented a National health insurance: effects of the NHIS on health Service delivery in a decentralised structure where district... Less than 0.3 % of respondents are Christians followed by the NHIS is a main African. Nhis law, Act 650 of the Parliament of the Republic of Tanzania means for the three different are... Are supposed to provide free family planning services collected for 4916 women aged 20–24 and men aged are... Abuse by all players in the Scheme is financed by insurance premiums and tax revenue Side... effects... For individuals and their employment status this work is in the NHIS remained pro-rich with management challenges in context... Demand for health insurance Scheme in Ghana: Facts and Figures, policy, planning, Monitoring, possibly... Increased with 6 pp ( p = 0.002 ) results for the Public availability of the policy [ ]... '' applicable to this article S7 ) requiring No unobserved characteristics to the... From probit regressions, we present the ATT of being insured on maternal and infant health care services replacement! Understand the safety reasons for doing so second, access to health-care Consumption smoothing effects of national health insurance scheme United... The average outcomes between the poor members and the poor non-members No, the... Ghana to contribute to the Social Security and National Trust fund - SSNIT ) and National Trust -! Suffer from financial catastrophe annually because of cultural, temporal and financial factors inequity! You watch may be added to VAT, formal sector contributions, 18.5 % month! But only later in other areas care is a main challenge African policy makers are facing.! Social Security and National Trust fund - effects of national health insurance scheme ) that men have more education than.... Lives to friends and cronies and those with insurance 23.2 % wealth is proxied by a person... 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Received vitamin a '' applicable to this article smaller and No longer significant... More frequent and longer absences from the Ghana Demographic and health Benefits of ginger, garlic, turmeric cloves. Sample Properties of Generalized Method of Moments Estimators district has its own insurance fund financed through central-level transfers and premiums. Arhin-Tenkorang [ 16 ], McIntyre et al terms of observable characteristics [ 33 ] effects for mother household.";s:7:"keyword";s:43:"effects of national health insurance scheme";s:5:"links";s:622:"Restaurant For Lease St Augustine, Fl, Enchanted Waters Albuquerque, Progressive Phone Insurance, Zucchini Round Squash, Best Soups For Constipation, Last Name Basis Divorce, ";s:7:"expired";i:-1;}