Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme

doi:10.1186/s12939-016-0401-1

. 2016 Jul 22;15(1):116.

doi: 10.1186/s12939-016-0401-1.

Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme

Genevieve Cecilia Aryeetey¹, Judith Westeneng², Ernst Spaan³, Caroline Jehu-Appiah⁴, Irene Akua Agyepong⁵, Rob Baltussen³

Affiliations

¹ School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Ghana. gcaryeetey@ug.edu.gh.
² Rutgers, Arthur van Schendelstraat 696, Utrecht, Netherlands.
³ Department for Health Evidence, Radboud University Medical Canter, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands.
⁴ African Development Bank, Human Development Department, Tunis, Tunisia.
⁵ School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Ghana.

PMID: 27449349
PMCID: PMC4957846
DOI: 10.1186/s12939-016-0401-1

Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme

Genevieve Cecilia Aryeetey et al. Int J Equity Health. 2016.

. 2016 Jul 22;15(1):116.

doi: 10.1186/s12939-016-0401-1.

Authors

Genevieve Cecilia Aryeetey¹, Judith Westeneng², Ernst Spaan³, Caroline Jehu-Appiah⁴, Irene Akua Agyepong⁵, Rob Baltussen³

Affiliations

¹ School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Ghana. gcaryeetey@ug.edu.gh.
² Rutgers, Arthur van Schendelstraat 696, Utrecht, Netherlands.
³ Department for Health Evidence, Radboud University Medical Canter, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands.
⁴ African Development Bank, Human Development Department, Tunis, Tunisia.
⁵ School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG 13, Legon, Ghana.

PMID: 27449349
PMCID: PMC4957846
DOI: 10.1186/s12939-016-0401-1

Abstract

Background: Ghana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty.

Methods: We conducted two repeated household surveys in two regions of Ghana in 2009 and 2011. We first analyzed the effect of OOPE on poverty by estimating poverty headcount before and after OOPE were incurred. We also employed probit models and use of instrumental variables to analyze the effect of health insurance on OOPE, CE and poverty.

Results: Our findings showed that between 7-18 % of insured households incurred CE as a result of OOPE whereas this was between 29-36 % for uninsured households. In addition, between 3-5 % of both insured and uninsured households fell into poverty due to OOPE. Our regression analyses revealed that health insurance enrolment reduced OOPE by 86 % and protected households against CE and poverty by 3.0 % and 7.5 % respectively.

Conclusion: This study provides evidence that high OOPE leads to CE and poverty in Ghana but enrolment into the NHIS reduces OOPE, provides financial protection against CE and reduces poverty. These findings support the pro-poor policy objective of Ghana's National Health Insurance Scheme and holds relevance to other low and middle income countries implementing or aiming to implement insurance schemes.

Keywords: Catastrophic expenditure; Ghana; Health insurance; Out-of-pocket expenditure; Poverty reduction.

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Figures

**Fig. 1**
Parade of insured households who fell into poverty due to OOPE

**Fig. 2**
Parade of uninsured households who fell into poverty due to OOPE

See this image and copyright information in PMC

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References

1. Whitehead M, Dahlgren G, Evans T. Equity and health sector reforms: can low-income countries escape the medical poverty trap? Lancet. 2001;358:833–836. doi: 10.1016/S0140-6736(01)05975-X. - DOI - PubMed
1. Wagstaff A, Van Doorslaer E. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Econ. 2003;12:921–934. doi: 10.1002/hec.776. - DOI - PubMed
1. O’Hara B. Do medical out-of-pocket expenses thrust families into poverty? J Health Care Poor Underserved. 2004;15(1):63–75. doi: 10.1353/hpu.2004.0008. - DOI - PubMed
1. Van Damme W, et al. Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia. Trop Med Int Health. 2004;9(2):273–280. doi: 10.1046/j.1365-3156.2003.01194.x. - DOI - PubMed
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[1] Whitehead M, Dahlgren G, Evans T. Equity and health sector reforms: can low-income countries escape the medical poverty trap? Lancet. 2001;358:833–836. doi: 10.1016/S0140-6736(01)05975-X. - DOI - PubMed

[2] Whitehead M, Dahlgren G, Evans T. Equity and health sector reforms: can low-income countries escape the medical poverty trap? Lancet. 2001;358:833–836. doi: 10.1016/S0140-6736(01)05975-X. - DOI - PubMed

[3] Wagstaff A, Van Doorslaer E. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Econ. 2003;12:921–934. doi: 10.1002/hec.776. - DOI - PubMed

[4] Wagstaff A, Van Doorslaer E. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Econ. 2003;12:921–934. doi: 10.1002/hec.776. - DOI - PubMed

[5] O’Hara B. Do medical out-of-pocket expenses thrust families into poverty? J Health Care Poor Underserved. 2004;15(1):63–75. doi: 10.1353/hpu.2004.0008. - DOI - PubMed

[6] O’Hara B. Do medical out-of-pocket expenses thrust families into poverty? J Health Care Poor Underserved. 2004;15(1):63–75. doi: 10.1353/hpu.2004.0008. - DOI - PubMed

[7] Van Damme W, et al. Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia. Trop Med Int Health. 2004;9(2):273–280. doi: 10.1046/j.1365-3156.2003.01194.x. - DOI - PubMed

[8] Van Damme W, et al. Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia. Trop Med Int Health. 2004;9(2):273–280. doi: 10.1046/j.1365-3156.2003.01194.x. - DOI - PubMed

[9] Krishna A. Escaping poverty and becoming poor: who gains, who loses and why? World Dev. 2004;32(1):121–136. doi: 10.1016/j.worlddev.2003.08.002. - DOI

[10] Krishna A. Escaping poverty and becoming poor: who gains, who loses and why? World Dev. 2004;32(1):121–136. doi: 10.1016/j.worlddev.2003.08.002. - DOI

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Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme

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Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme

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