NATIONAL HEALTH INSURANCE SCHEME: PREDICTORS OF CARD RENEWAL AMONG SUBSCRIBERS IN THE EAST GONJA DISTRICT

ABSTRACT

Introduction: Ghana‟s National Health Insurance Scheme (NHIS), which was established in 2003 by Act 650, had an objective of reaching a hundred percent coverage within five years of its operations. The scheme is over ten years old with a reported national coverage of about 60% and active membership of about 35%. A number of reasons have been identified to account for the slow progress by the scheme towards universal coverage. National health insurance renewal rate among insurance subscribers has not been reported in the East Gonja District. However, the drop-out rate reported in the district was higher (37%) than the reported average (16%) across the country. The reasons for non-renewal as reported across the world include low levels of income and low levels of awareness of insurance benefit package among enrollees residing in the district. This study sought to identify and assess the determinants of health insurance card renewal among subscribers in the East Gonja District. Methods: A descriptive cross-sectional quantitative method was employed to assess individual, provider and scheme related factors that influence renewal of health insurance membership in the East Gonja District. A sample of three hundred and eighty National Health Insurance Scheme subscribers, were randomly interviewed in households from 1st June to 1stJuly, 2016. STATA version 13 software was used to analyze the data by descriptive and regression analysis using Chi-square as the statistical test.

Results: Three hundred and eighty insurance enrollees aged 18-69 years participated in the study. Out of the 380 respondents, 264 (69.5%) were active members of the scheme whilst 116(30.5%) failed to renew their membership. The study demonstrates that NHIS members‟ knowledge of their card‟s expiry date has the strongest

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association (p=0.001) with the decision to renew insurance subscription. Scheme staff attitude, benefit package and premium price as scheme factors; and waiting time, provider staff attitude, drug availability and distance to facility as provider factors were found not to influence insurance renewal decisions. Conclusion: National Health Insurance active membership was high, (69.5%) compared to the reported national average (35%) among subscribers in the East Gonja District. The subscribers‟ decisions to purchase national health insurance through card renewal were not influenced by provider, scheme and individual factors. However, an individuals‟ awareness of the expiry date on insurance card was a significant predictor of insurance renewal. This highlights the need to have reminders on expiry dates of National Health Insurance Scheme membership to increase renewal rates.