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Randomized Controlled Trial
. 2022 Oct;31(10):2120-2141.
doi: 10.1002/hec.4556. Epub 2022 Aug 9.

The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment

Stephen Kwasi Opoku Duku  1 , Edward Nketiah-Amponsah  2 , Christine J Fenenga  3 , Wendy Janssens  4 , Menno Pradhan  5
Affiliations
Randomized Controlled Trial

The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment

Stephen Kwasi Opoku Duku et al. Health Econ. 2022 Oct.

Abstract

Health insurance enrollment in many Sub-Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical-technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured.

Keywords: Ghana; community participation; health insurance; universal health coverage.

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Conflict of interest statement

All authors report financial support from The Netherlands government through the Ministry of Foreign Affairs and the Science for Global Development (WOTRO) which is a division of the Netherlands Organization for Scientific Research (NWO), under the Global Health Policy and Systems Research (GHPHSR) program (Project No. W07.45.104.00), during the conduct of the study.

Figures

FIGURE 1
FIGURE 1
Timeline of intervention implementation activities
FIGURE 2
FIGURE 2
Participation in the 2012 and 2014 surveys
See this image and copyright information in PMC

References

    1. Adhvaryu, A. , & Nyshadham, A. (2015). Return to treatment in the formal health care sector: Evidence from Tanzania. American Economic Journal: Economic Policy, 7(3), 29–57. 10.1257/pol.20120262 - DOI - PMC - PubMed
    1. Alhassan, R. , Duku, S. , Janssens, W. , Nketiah‐Amponsah, E. , Spieker, N. , van Ostenberg, P. , Arhinful, D. K. , Pradhan, M. , Rinke de Wit, T. F. , & deWit, T. (2015). Comparison of perceived and technical healthcare quality in primary health facilities: Implications for a sustainable national health insurance scheme in Ghana. PLoS One, 10(10). 10.1371/journal.pone.0140109 - DOI - PMC - PubMed
    1. Alhassan, R. , Nketiah‐Amponsah, E. , & Arhinful, D. (2016). Design and implementation of community engagement interventions towards healthcare quality improvement in Ghana: A methodological approach. Health Economics Review, 6, 49. 10.1186/s13561-016-0128-0 - DOI - PMC - PubMed
    1. Alhassan, R. , Nketiah‐Amponsah, E. , Ayanore, M. , Afaya, A. , Salia, S. , Milipaak, J. , Ansah, E. K. , & Owusu‐Agyei, S. (2019). Impact of a bottom‐up community engagement intervention on maternal and child health services utilization in Ghana: A cluster randomised trial. BMC Public Health, 19, 791. 10.1186/s12889-019-7180-8 - DOI - PMC - PubMed
    1. Alhassan, R. , Nketiah‐Amponsah, E. , Spieker, N. , Arhinful, D. , Ogink, A. , vanOstenberg, P. , & deWit, T. (2015). Effect of community engagement interventions on patient safety and risk reduction efforts in primary health facilities: Evidence from Ghana. PLoS One, 10(11). 10.1371/journal.pone.0142389 - DOI - PMC - PubMed

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