Out-Of-Pocket Healthcare Expenses Under the National Health Insurance Scheme in Ghana

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.