The National Health Insurance (NHI) is a health financing system that is designed to pool funds to provide access to quality affordable personal health services for all South Africans based on their health needs, irrespective of their socio-economic status. 2008;23:150â60. The probability that a mother who is married or living together is enrolled is 7 pp higher (p = 0.082), while mothers from the three largest ethnic groups in our sample: Akan, Ewe or Mole-Dagbani are significantly less likely to enroll compared to those from the minority ethnic groups (including Ga-Adang me, Guan, Grusi, Gruma and Mande). In: Culyer AJ, Newhouse JP, editors. [13]. 39.8% of the children in our sample have a mother who is insured. The weights are determined by the inverse of the distance to the propensity score of the child. No, Is the Subject Area "Ghana" applicable to this article? Delivery in Health Facility - Probit Regressions. 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. Liu T, Chen C. An analysis of private health insurance purchasing decisions with national health insurance in Taiwan. We analyze these data at the level of the child and have information about every pregnancy preceding the birth of that specific child for the period 2006–2008. The national health insurance scheme (NHIS) was established under Act 650 of 2003 by the Government of Ghana to provide essential health care services to persons' resident in the country through district mutual health insurance scheme (DMHIS) and private health insurance schemes. NHIS had no effect on services not covered by the insurance (vitamin A supplements and child vaccinations), which is in line with our expectations. The National Health Insurance Scheme (NHIS) is a social intervention program introduced by government to provide financial access to quality health care for residents in Ghana. We present simple descriptive statistics of the main background characteristics that will be used in the subsequent sections of the paper. Further, living in the Brong-Ahafo and the Upper East region is more common among those with insurance. A detailed description of these algorithms can be found in Khandker et al. Amsterdam: Elsevier Inc; 2000. p. 563â643. "This thesis is about promoting a sustainable National Health Insurance Scheme (NHIS) in Ghana through improved client-centred quality care and effective community engagement in quality care assessment. The program suffered from low awareness, limited reimbursement to the facilities and no monitoring of the implementation [31], making it difficult to determine who received an exemption and who did not. We use the GDHS 2008, a nationally representative household survey with individual data collected for 4916 women aged 15–49 [7]. Article These results are robust to the inclusion of different sets of explanatory variables that account for socio-demographic and economic characteristics, as well as for proxies of the supply side of the health sector in Ghana. 2009;17:45â59. This book is a study of the reforms of primary care in Europe as well as their impacts on the broader co-ordination mechanisms within European health care systems. https://doi.org/10.1371/journal.pone.0165623.t002. Most of the new national health insurance proposals assume governmental assurance of universal cover-age. Using cross sectional data for propensity score matching (PSM) Blanchet et al. Source: 2014 Ghana DHS- Own elaboration. They invite friends, Neighbour’s, colleagues to use one single NHIS number for all activities while they can encourage them instead to do a registration of their own. Ghana's National Health Insurance Scheme (NHIS) was created by the National Health Insurance Act of August 2003, and is one of very few attempts by a sub-Saharan African country to implement a national-level, universal health insurance program. Minister for Health and Social Affairs, Sweden Having visited AIIMS & other healthcare facilities I would like to appreciate the efforts of the staff that works towards making the scheme available to all. The scheme significantly increased the proportion of pregnancies with at least four antenatal care visits with 7 percentage points and had a significant effect on attended deliveries (10 percentage points). No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, Corrections, Expressions of Concern, and Retractions, https://doi.org/10.1371/journal.pone.0165623, https://dhsprogram.com/data/new-user-registration.cfm, http://dhsprogram.com/data/dataset/Ghana_Standard-DHS_2008.cfm?flag=0, http://www.nwo.nl/actueel/nieuws/2011/Toekenningen+Vernieuwingsimpuls+Veni+bij+MaGW.html, http://paa2013.princeton.edu/papers/131745, http://www.nhis.gov.gh/files/2013%20Annual%20Report-Final%20ver%2029.09.14.pdf, http://ideas.repec.org/c/boc/bocode/s432001.html, http://www.oxfam.org/sites/www.oxfam.org/files/rr-achieving-shared-goal-healthcare-ghana-090311-en.pdf. We estimated a bivariate probit model which fits maximum-likelihood two-equation probit models and allows to take into account both the binary nature of the endogenous variable (NHIS enrollment) and the binary nature of the outcome variables (formal antenatal care, delivery in health facility, delivery assisted by a trained person, out-of-pocket expenditure). Yes We thank MeasureDHS for the public availability of the Ghana Demographic and Health Survey 2008. 36-6th Avenue, Opposite AU Suite, Ridge Residential Area, Accra. Using cross-country analysis and case studies, this book provides new insights and potential policy responses for the key fiscal policy challenges that both advanced and emerging economies will be facing. Witter S, Garshong B. The book demonstrates that having one or more uninsured members in a family can have adverse consequences for everyone in the household and that the financial, physical, and emotional well-being of all members of a family may be adversely ... Even though there is some evidence of large coverage levels, the effect of the . Jutting J. No, Is the Subject Area "Vitamin A" applicable to this article? The other half of the funding comes from taxes. Insurance enrollment had almost no effect on child vaccinations. There have been several attempts to change or modify the Act establishing the Scheme but it ends up not being attended to by successive Parliaments; the 8th Assembly also being a culprit. Source: 2014 Ghana DHS- Own elaboration, NHIS enrollment by education level. Is the Subject Area "Vaccination and immunization" applicable to this article? The pregnancy too soon or unwanted does not directly relate to services covered by the health insurance (family planning services are not covered under the NHIS) but could reflect potential spill-over effects i.e. Ghanaâs national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching. What cream can I use to tighten my Vigina? Abt Associates Inc., Berthesda, MD Google Scholar Can drinking cold water or hot water prevent pregnancy? The lower response rate for men was likely due to their more frequent and longer absences from the household. To provide additional insights into the details of the child vaccinations, we also present five additional outcomes: polio vaccination at birth, Bacillus Calmette-Guérin (BCG) vaccination, three additional polio vaccinations, three Diphtheria, Tetanus and Poliomyelitis (DTP) vaccinations and measles vaccination. A rejection of the null hypothesis casts doubt on the validity of the instruments. 2. Ministry of Health Ghana. Furthermore, high quality data is needed to assess the impact of these reforms and researchers and policy makers often resort the randomized experiments in order to draw conclusions on the causality nexus because rich micro-data are hard to collect. Privacy 1958;26:393â415. Subsequently, a number of initiatives have been put in place to simultaneously address sustainability challenges, reach universal access to health care and improve efficiency and transparency of the health system. Through a principal component analysis, each asset was assigned a weight and then standardized in relation to a normal distribution. There has not been stability in the Scheme such that periodic reviews have become impossible. Health service utilisation, or accessibility to health services, were strongly affected by the existence of a chronic condition within the household; a regular situation arose in the health insurance scheme, known as adverse selection, where people who are prone to suffering from health problems are more likely to acquire health insurance . Discover a faster, simpler path to publishing in a high-quality journal. We therefore apply PSM to identify the control observations (non NHIS members i.e. Moreover, the dearth of health-care professionals and the low availability of government health-facilities, proxied respectively by the population per doctor and by the population per health facility, are a disincentive to seek formal health care. As indicator of antenatal care we consider whether a woman received care from a health professional (doctor, nurse, midwife or community health officer). [17] and Mensah et al. Any proposal for national health insurance such as a Canadian-style system must ultimately be based on principles of access, cost, and quality care. We found that NHIS enrollment significantly increased the percentage of children whose mother obtained at least four antenatal care (ANC) visits, had a skilled health care worker present during birth and that were born with a caesarean section. Citation: Bonfrer I, Breebaart L, Van de Poel E (2016) The Effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilization. The probability that a 20 to 35 years old mother enrolls in the NHIS is 11 percentage points (pp) higher (p = 0.034) compared to younger women and for mothers above 35 years old this probability is even 18 pp higher (p = 0.003). Today, the NHI covers more than 98% of Taiwan's population and enrollees enjoy almost free access to healthcare with small co-payment by most clinics and hospitals. Wang H, Zhang L, Yip W, Hsiao W. Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China. Towards universal health insurance coverage (Nonthaburi, Health Care Reform Project, Ministry of Public Health). With the introduction of the National Health Insurance Scheme (NHIS), which is a form of Health care financing in order to serve as a conduit for providing financial access to health care. Most of the formal sector workers contribute to the SSNIT fund through a payroll deduction of 2.5 %. Information about whether a child received vitamin A and the relevant vaccinations was based on the information recorded on the vaccination card. This paper focuses on the experience of Ghana, where a National Health Insurance Scheme (NHIS) was fully implemented by the end of 2004 [7â10]. Social health insurance in Ghana. Vaccinations provided at some stage after birth were calculated on the subsample of children born at least one year prior to the survey, reflecting that these vaccinations are obtained over the course of the first life year. Balance was achieved on all covariates apart from Mother’s religion Muslim and Mother’s ethnicity Mole-Dagbani. Michael Grimm for their health care use a case study of 400 heads of and. And subsequent publication of Statutory Instrument ( SI ) No M, Akazili J, et al apply score. 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