Economic inequalities in health insurance subscription renewal: Evidence from Ghana's National Health Insurance Scheme.

Ghana's national health insurance scheme (NHIS) is considered a major step towards achieving Universal Health Coverage (UHC) in the country. However, over the years the scheme has faced challenges, including subscription non-renewal, that threaten its sustenance. In this study, we estimate and analyse the nature of economic inequalities in NHIS subscription renewal and determine factors that contribute to the observed inequality. Data from the seventh round of the Ghana Living Standard Survey (GLSS) was used for the study. A sample of 40,170 ever insured individuals was included in the analysis comprising 18,066 males and 22,104 females. We computed concentration indices (CIs) and used linear regression techniques to decompose the CIs. The results show that NHIS renewal is pro-rich [CI = 0.126; P < 0.01] and favored males [CI = 0.110; P < 0.01] and urban dwellers [CI = 0.066; p < 0.01]. Major contributors to the observed inequality in subscription renewal include premium and processing fees payment, access to information, and economic wellbeing. The observed rural-urban and male-female differences in subscription renewal were explained by differences in premium and processing fee payments, education outcomes, employment status and access to information. The findings suggest that interventions that reduce cost barriers to NHIS subscription for the poor, improve physical access to healthcare and improve sensitization efforts should be encouraged.

Spatial analysis of the effect of microfinance on poverty and inequality in Ghana.

Although microfinance is usually delivered with a spatial outlook, the literature is so far silent on the potential spatial effect of microfinance delivery. The aim of this study was, therefore, to examine the effect of microfinance intensity on spatial inequality and poverty in Ghana. Using the 6th (2012/2013) and 7th (2016/2017) rounds of data from a national survey on living standards in Ghana, the study first examined the pattern of district-level poverty and inequality in Ghana and then adopted spatial econometric techniques to explore the spatial correlation between microfinance, inequality, and poverty. The results revealed that microfinance has a significant negative impact on spatial inequality and poverty in Ghana. The spatial effect of microfinance intensity on poverty and inequality is characterized by both direct and spillover effects on neighbours. It was identified that the outreach of microfinance drives within-district disparity, whereas the disparity in microfinance credit distribution powers between-district disparity. Additionally, while there is evidence of an indirect effect, the indirect effect diffuses monotonically as the number of neighbours increases. The study's findings advocate for a complementary approach to microfinance delivery, as well as the elimination of institutional barriers that limit access, availability, and operational delivery of microfinance services in order to achieve spatially optimal microfinance delivery. Supplementary Information: The online version contains supplementary material available at 10.1007/s40847-022-00210-3.

Determinants of paying national health insurance premium with mobile phone in Ghana: a cross-sectional prospective study.

INTRODUCTION: In an effort to increase Ghana's National Health Insurance Scheme (NHIS) enrollment and retention rates, the NHIS introduced membership renewal and premium payment by mobile phone. The success of such an innovation dependents on many factors including personal and community characteristics of members. OBJECTIVE: The objective of the study is to investigate the determinants of renewing membership and paying the NHIS premium through a mobile phone. METHODOLOGY: The prospective cross-sectional survey was used to solicit the required information from about 1192 respondents living in Kumasi Metropolis, Atwima Nwabiaya and Sekyere Central Districts of Ghana. Logistic regression model was employed to estimate the determinants of paying the NHIS premium with the mobile phone. RESULTS: The study found that factors including residing in an urban area (Kumasi metropolis), senior high education, tertiary education and informal employees are the determinants of paying the NHIS premium with the mobile phone. CONCLUSION: It is recommended that the NHIS consider making the mobile payment as simple as possible for the less educated and the rural members to access it.