Enrolment Of Urban Poor In National Health Insurance Scheme In The Ga East Municipality

ABSTRACT Background: The National Health Insurance Scheme is a financial arrangement that enable citizens of Ghana to access health care service without having to pay at the point of service delivery. This somehow ensures an improvement in the quality of basic health rendered to the people. Health insurance schemes are thus seen as viable alternatives in providing more sustainable and equitable health delivery system in countries. To improve fairness in the provision of health care and provide risk protection to poor households, low – middle income countries are increasingly gearing toward social health insurance. In 2003, National Health Insurance Authority Art 650 was passed in Ghana’s Parliament. The scheme was to replace the hitherto unpleasant Cash and Carry system of paying for health care at the point of service. Even though there was some evidence of large coverage levels, the effect of the NHIS on health care demand and out of pocket expenditures have still not been fully examined. The objective of this study was to estimate the level of enrolment of urban poor in the NHIS in the Grushi community. It was also to determine factors that motivate the people to enroll in the NHIS. Methodology: A cross sectional study was conducted in the Grushi community of Ga East Municipality of the Greater Accra Region using data from a household survey of 250 household participants. Data were collected from household level and analyzed with Stata software. The study employed descriptive statistics to analyze the factors that influence the urban poor to enroll in the scheme. Results: Findings indicated that majority of participants considered poor in the Grushi community were enrolled in the National Health Insurance Scheme. This study found interesting evidence of inequity in enrolment in NHIS. Generally there was a higher enrolment among the urban poor people. Additionally, the respondents indicated that though the NHIS does not cover all their healthcare cost when they visit the hospital, their total bill is reduced by more than half due to the insurance, which motivate them to enroll in the scheme. Furthermore, it was also found that individuals need for care was associated with the decision to enroll in the scheme. Conclusion: There has to be a better method of identifying the poor, and the provision of premium exemptions needs to be looked at if the NHIS is to achieve its objective of total enrollment in the scheme. The study found out that urban poor people are more likely to enroll in NHIS in the Grushi community. Factors such as sex, education, employment and health status were found to be predictors of health insurance enrolment among the people in the community.