effects of national health insurance scheme

Risk Pooling. The NHIS operates in a decentralised structure where every district has its own insurance fund financed through central-level transfers and individual premiums . They believe it is their right and refusal leads to threat to invite another player. Competing interests: The authors have declared that no competing interests exist. The age distribution shows that more than half of women and men are under the age of 30. In a systematic review of the literature [24] show that also in developing countries mass media campaign via television, radio, newspaper, internet or promotional hotline are effective in expanding health insurance coverage. There is considerable interest in exploring the potential of health insurance to increase the access to, and the affordability of, health care in Africa. Found insideWith contributions from leading health economists and policy experts, the book considers the many dimensions of governance, institutions, methods, political economy, and ethics that are needed to decide what’s in and what’s out in a way ... Health insurance was introduced in Nigeria and it kicked off gradually not moving past a coverage of about 5-7percent of Nigerians enrolled in it mostly from the FG formal sector and the organized private sector. J Public Econ. 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. Chetty R, Looney A. 1958;26:393–415. We limit our analysis to the most recent live birth, up to two years preceding the interview, to increase credibility of this assumption. We estimated probit and bivariate probit models to take into account the issue of self selection into the health insurance schemes. Head Office: Plot 297, P.O.W. However, we acknowledge that the results for out-of-pocket expenditures need to be considered with caution since we are only able to measure the effect of the NHIS enrollment at the extensive margin. Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. First, in order to assess the effectiveness of the NHIS, it is extremely important to acknowledge the role of the supply side because improved access to health-care through the NHIS will not necessarily increase the utilization for health-care if the services are not easily available and if the quality is questionable. Soc Sci Med. The estimation of economic relationships using instrumental variables. 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. Health insurance can protect households from the risk of medical expenses which can be large relative to modest incomes [1] and therefore cause households to fall into poverty [2]. Expanding health insurance coverage in vulnerable groups: a systematic review of options. Having verified that the balancing property is satisfied, we present the ATT of being insured on maternal and infant health care use. Abuse is another huge challenge facing the Scheme. Caesarean sections also increased significantly with 3 pp (p = 0.023), which is half of the effect in the full sample. Health Sector ICT Policy and Strategy. In Nigeria, nothing is ever the same as it is. Table S4. The National Health Insurance Scheme (NHIS) in Ghana was established by the National Health Insurance Act, 2003 (Act 650) and National Health Insurance Regulations, 2004 (L.I. Fig 1 shows the propensity scores for both the treated and the untreated. source Others were covered by insurance that offered only partial protection. The NHIS allocate lives to friends and cronies and those with huge financial lobbying abilities. England: Ashgate publication; 2005. (DOC 427 kb). In Thailand in 2001, before the Universal Coverage Scheme (UCS), nearly one in four people were uninsured. Considerable socio-economic inequalities in enrollment exist [22]: better-off households are significantly more likely to enroll compared to the poorest quintile, with respective enrollment rates of 41 and 27 percent [23]. Most of the new national health insurance proposals assume governmental assurance of universal cover-age. Second, access to health insurance is expected to reduce out-of-pocket health expenses [3, 4]. It may reduce other consumption (including spending on food and education) and may have both an immediate and intergenerational effect on household poverty and on the equity of heath-service delivery. What cream can I use to tighten my Vigina? In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) to minimize out-of-pocket expenditure at the point of use of service. Since 2005, 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. The National Health Insurance Scheme (NHIS) is a body corporate established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost. Balance was achieved on all covariates apart from Mother’s religion Muslim and Mother’s ethnicity Mole-Dagbani. [6], make the same assumption but include births up to four years prior to the survey. National Health Insurance Scheme (NHIS) resulted in high satisfaction levels and self-rated health among federal civil servants employed in Bayelsa State, Southern Nigeria for many types of service. The other half of the funding comes from taxes. However, our matching on extensive information on maternal, household, child, regional and time characteristics, including socio-economic status, should eliminate most of the important drivers of selection bias, though some bias due to unobserved differences is likely to remain. More specifically, the data include information on the respondent’s background, health, reproduction and contraception, husband’s background and woman’s occupation [15]. Since membership is mandatory, the adverse selection problems which smaller, voluntary health insurance schemes face are overcome. The regulators who are supposed to provide direction and leadership are in need of direction and leadership themselves. medical supplies have had spill over effects in various sectors, particularly chemical, trade, electricity and . In particular, we find that being enrolled in the NHIS positively affects the probability of formal antenatal check-up before childbirth, the probability of childbirth taking place in a health facility, and the probability of being assisted during birth by a trained person. We focus on the recent experience of Ghana, where a National Health Insurance Scheme (NHIS) became law in 2003 and fully implemented from late 2005. This paper focuses on the experience of Ghana, where a National Health Insurance Scheme (NHIS) was fully implemented by the end of 2004 [7–10]. Abuse by all players in the industry; NHIS itself, HMOs, Health care facilities and enrollees. We analyze the 2014 GDHS, which includes retrospective information on the pregnancies and births that took place in the five years preceding the survey. 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). I hope one day we can call experts to sit down and review the Scheme. However, the problem arose when the government decided to use a 2.5% deduction of workers contribution to the Social Security and National Insurance Trust (SSNIT). Meng Q, Yuan B, Jia L, Wang J, Yu B, Gao J, et al. Under normal circumstances, the World Health Organization (WHO) recommends that a woman without complications have at least four antenatal care visits, the first of which should take place during the first trimester (descriptive statistics of antenatal care are provided in Additional file 1: Table S2). To check the validity of the excluded instruments we perform a Sargan-Hansen test of overidentifying restrictions in a linear-equivalent model setting [25, 26]. Caesarean sections increased (6 percentage points) and the number of children born from an unwanted pregnancy decreased (7 percentage points). NHIS enrollment by Region. However, since [13] do not control for economic characteristics such as wealth and occupation, and [14] do not take into account the issue of self selection into enrollment, the results are not fully comparable. Ministry of Health Ghana. Article  The individuals in the sample were then ranked according to the total score of the household in which they resided and divided into quintiles from one (poorest) to five (richest). The Ghanaian government implemented the National Health Insurance Scheme in 2004 and the aim of this study is to evaluate its early effects on maternal and infant healthcare use. The Scheme is in a mess that is not understandable both by this government or the past one. It brings together several elements of health system development and challenges and links it to health financing and delivery performance. The volume reviews the situation among human resources for health and pharmaceuticals. Since its launch in 1999, the National Health Insurance Scheme (NHIS) has been the major initiative to expand health insurance in Nigeria. To our knowledge there were no nationwide, continuous initiatives before the implementation of the NHIS to provide free family planning services. Other authors suggest that fees could be too high for the poor [24], awareness about insurance low, or the perceived value for money insufficient [25,26]. The main objective of the Authority is to implement and operate the National Health Insurance Scheme, manage the National Health Insurance Fund, accredit health insurance healthcare providers, develop a comprehensive benefits package to be accessed by members, register & issue membership cards to members and facilitate member access to quality . As it is well-known, the standard single demand function estimation for health service expenditure results in biased estimates when a significant proportion of individuals in the sample are non-consumers. Indeed, taking into account the issue of sample selection into enrollment, the marginal effect of the NHIS enrollment is positive and statistically significant in the regressions for antenatal checkup, delivery in health facility, and delivery assisted by a trained person. Find the right health care provider for you and your family . Yet while this expansion of coverage will almost inevitably have improved access to health care, however, it cannot be assumed that it will . Background Characteristics of the sample. It evaluates the impact of the country's National Health Insurance Scheme on . More dependants attract additional contributions. Many households in Ghana are exposed to risks from preventable diseases, poor weather, and economic mismanagement but they have limited access to quality health care because of existing ineffective financing options, especially for the poor ... Extending health insurance: effects of the national health insurance scheme in Ghana. California Privacy Statement, The major objectives of antenatal care are to identify and treat problems during pregnancy. 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). Yes This paper attempts to fill this gap, investigating how the NHIS affects the utilization of maternal health care services and medical out-of-pocket expenses. 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. 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 ... The validity of the PSM approach generally depends on two conditions: i) conditional independence and ii) sizeable common support or overlap in propensity scores across the treated and the matched control sample [36,38]. 2009;17:45–59. As already suggested by the descriptive analysis, the better off are more likely to seek antenatal care: the marginal effect of the highest income group is always positive and statistical significant. Yes Provided by the Springer Nature SharedIt content-sharing initiative. This might be caused by spill-over effects i.e. 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. We hypothesize to find no effect of the NHIS on infant vaccinations and use this outcome as a robustness measure to determine whether we indeed find no effect on this outcome. The results are robust with regard to the inclusion of different sets of explanatory variables that account for socio-demographic and economic characteristics, as well as the proxies of the supply side. 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. 12 A newly-created National Health Insurance Authority (NHIA) was commissioned "to secure the . The bill imposed a national health insurance levy on members of the scheme in order to finance the scheme. If playback doesn't begin shortly, try restarting your device. PubMed Central  The distribution of respondent by urban/rural residence shows that about 50 % of women and men live in urban areas. Can Andrew liver salt remove early pregnancy? The effect of the National Health Insurance Scheme (NHIS) on health service delivery in mission facilities in Ghana: a retrospective study Genevieve Cecilia Aryeetey1, Justice Nonvignon1, Caroline Amissah2, Gilbert Buckle2 and Moses Aikins1* Abstract Background: In 2004, Ghana began implementation of a National Health Insurance Scheme (NHIS) to . Access to more generous health insurance is hypothesized to affect households in several ways. A second limitation is related to the assumption that women’s enrollment status at the date of the interview is representative for their status during their pregnancy in the last two years. The authors declare that they have no competing interests. Accordingly, extending geographical access is an important strategy for expanding NHIS membership and improving access to health-care. We proxy socioeconomic status with the wealth index provided in the GDHS which is estimated through principal component analysis on a large set of assets and dwelling characteristics. Beyond fragmentation and toward universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania. Indeed, their contributions were supposed to be defined according to income so that the lowest-income group pays a premium of 7.20 Ghanaian cedi (GH¢) or US$ 8, while those in the highest income group pay a premium of GH¢ 48.00 or US$ 53. Nigeria is eager to achieve UHC. On the contrary, in the regressions for out-of-pocket expenses the marginal effect of the NHIS enrollment is not significant anymore. This result is a novelty with respect to preliminary findings obtain with the 2008 Ghana Demographic Health Survey and actually reflects the effort made in recent years by the Government of Ghana to reduce inequality in health care access. Ensuring validity of PSM in relation to the second condition is done in line with general practice by only considering observations on the common support of the propensity scores across the treated and the matched controls [36]. Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country. This became necessary for posterity sake because in my opinion I believe the health insurance industry though might be the answer will crash in a few years. In the subsample of households selected for the male survey, 4,609 eligible men were identified and 4,388 were successfully interviewed, yielding a response rate of 95 %. No, Is the Subject Area "Antenatal care" applicable to this article? Ghana Health Service. Our first research question partially overlap [14] even though, contrary to our approach that will be extensively explained later, they did not take into account the issue of self selection into the health insurance schemes. The majority of respondents are Christians followed by Muslims and other (spiritualist or animist). The government has since worked to expand JKN enrollment with an original aim to achieve universal health insurance coverage by 2019. 3. As indicator of antenatal care we consider whether a woman received care from a health professional (doctor, nurse, midwife or community health officer). To study the effects of NHIS enrollment among lower socio-economic groups, we estimated the effects among the children from poor households (for sample sizes see Table 1). This policy aimed to abolish premiums for pregnant women and to automatically cover newborns to avoid creating a gap between the time of birth and the registration of the newborn. There is considerable interest in exploring the potential of social health insurance in Africa where a number of countries are currently experimenting with different approaches. Witter S, Garshong B. Any proposal for national health insurance such as a Canadian-style system must ultimately be based on principles of access, cost, and quality care. BMC Int Health Hum Rights. We analyzed the 2014 GDHS focusing on four outcome variables, i.e. 2008;86:871–6. Each household was then assigned a score for each asset, and the scores were summed for each household. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The household wealth is proxied by a wealth quintile index which is a measure of the combined indicators of household income and expenditure. The National Health Insurance Scheme (NHIS) took off in the year 2005 and is a corporate body established under Act 35 of 1999 Constitution by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost through various prepayment systems. Correspondence to In these regressions we consider the most complete specification which includes also proxies of the supply side (population per health facility and population per doctor). Given the general poor state of health care and the devastating effect of user fee, the National Health Insurance Scheme (NHIS) was instituted as a health financing policy with the main purpose to ensure universal access for all Nigerians. Paper presented at the Promoting Resilience through Social Protection in Sub-Saharan Africa, Dakar, Senegal. 2002;92:51–76. Urban residents are more likely than rural residents to be covered by the NHIS. Ministry of Health Ghana. Mensah et al. No. Our results are generally in line with, but smaller than, the study by Mensah et al. One unpublished study [8] did estimate the early nationwide effects of the NHIS. The Scheme is voluntary. We also include indicators for each birth quarter (three month period) within the time period in our data to pick up any time-varying characteristics. 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). 7 The NHIF generates its cash inflow from five sources including 2.5% of the 17.5% Value-Added Tax (VAT), 2.5% of the 17.5% Social Security and National Insurance Trust (SSNIT) from formal sector employees, dividends of . Policymakers in Nigeria are Brugiavini, A., Pace, N. Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care. During our study period, the early years of the NHIS, delivery care was part of the benefit package. About forty percent of children had a mother who is enrolled in this insurance. While the proxies of economic well-being are all taken into account and included as regressors in the empirical analysis, the proxies of individual preferences are unobservable. The implementation of the scheme was accompanied by increased access and use of health care services. The National Health Insurance Scheme (NHIS) is an insurance policy enacted by government in the early years of 2000 to eradicate the "cash and carry" system and provide a better health care for all Ghanaians. One wonders how they claim humans have two thyroid glands sometimes when they claim to have done full thyroidectomy twice in a space of 2 years….
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