Determinants of nonrenewal of National Health Insurance (NHI) membership cards among healthcare workers in the Kintampo North Municipality, Bono East Region of Ghana

ABSTRACT

Introduction: National Health Insurance Scheme (NHIS) was implemented in Ghana in 2004 to serve as the lifeline to realizing Universal Health Coverage (UHC). Available evidence suggests that, formal sector workers do not promptly renew their expired NHIS membership cards. This study was therefore conducted to unearth factors responsible for the failure of healthcare workers in the Kintampo North Municipality to promptly renew their health insurance membership whenever it expires. Methods: a descriptive cross-sectional design was used to conduct this study, where three hundred and ninety-seven (397) participants were recruited using a proportionate stratified sampling technique. All variables with a p-value <0.25 at the bivariate analysis level were selected and put into multiple logistic regression analysis models for statistical significance (p-value < 0.05). Odds ratios with their corresponding 95% Confidence Interval were reported. A p-value < 0.05 was set as level of significance. Results: almost all the respondents (94.0%) had NHIS membership cards; out of which 70.7% had valid membership cards. Fourty percent did not renew their expired NHIS membership cards for more than 7 months. From the study, reasons given for health workers´ inability to promptly renew NHIS membership included 212 (19.8%) indicated forgetfulness, busy schedules 191 (17.9%), procrastination 167 (15.6%), self-medication 170 (15.9%) and utilization of spiritual homes (4.5%). All socio-economic factors were significantly associated at the bivariate level (p<0.05). However, in the multiple logistic regression model, employment status, the type of health staff and monthly salary lost their statistical significance. Conclusion: NHIS subscription and membership renewals are high among healthcare workers who participated in the study in Kintampo North District of the Bono East Region of Ghana. However, there is the need to encourage those who do not renew their expired cards by NHIA and its accredited facilities sensitizing the general populace on the utilization of mobile phones to renew NHIS membership cards in order to prevent long waiting time and bureaucracies in renewing NHIS cards. It will be prudent for NHIS to liaise with Government of Ghana (GoG) to put measures in place to facilitate automatic membership renewals for public sector workers who for some other reasons often fail to renew their cards.