Artikel
Baseline study of the ReachUHC project to assess acceptability of mobile-phone-based interventions to improve health insurance coverage in Ghana
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Autoren
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Mawumenyo Kwawukume
- Kwame Nkrumah University of Science and Technology – School of Public Health, Kumasi, Ghana
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Laura Nübler
- Technische Universität Berlin – Department of Empirical Health Economics, Berlin, Germany
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Kofi Akohene Mensah
- Kwame Nkrumah University of Science and Technology – School of Public Health, Kumasi, Ghana
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Ellis Owusu-Dabo
- Kwame Nkrumah University of Science and Technology – School of Public Health, Kumasi, Ghana
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Martin Siegel
- Technische Universität Berlin – Department of Empirical Health Economics, Berlin, Germany
| Veröffentlicht: | 28. November 2023 |
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Gliederung
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Background: Universal health coverage aims to protect households from catastrophic health expenditures. However, recent studies found forgetfulness and being too busy to contribute to low health insurance renewal rates in Ghana. To reduce gaps in coverage, mobile-based reminder and auto-renewal options will be introduced in Kumasi, with Accra as control site. In the baseline study, we analyze NHIS routine data to investigate the demographics of active members. We also conduct a baseline population survey in Kumasi and Accra, which we use to ascertain the acceptability and inform the design of our proposed intervention.
Methods: Using a full sample of NHIS transaction records for the years 2018–2021, we estimate descriptive statistics for our outcomes of interest. The population survey employs a cross-sectional design with two-stage cluster sampling of the treatment and control populations. We survey 811 individuals (379 in Kumasi and 432 in Accra) in 564 households (284 in Kumasi and 280 in Accra) to collect baseline data on household and sociodemographic characteristics, health insurance status, intervention acceptability, and user preferences.
Results: NHIS routine data shows a stark reduction in coverage among men when they turn 18 years old and lose exemption status, while coverage among women of that age remains high. In the survey population, adult men were 3 times more likely to report never having registered for insurance. Almost 50% of nonrenewers reported that they forgot or were unaware of their upcoming expiry date. 93% of all individuals endorsed mobile-phone based reminders, and 69% supported an auto-renewal option. Financial barriers were stated only by a minority of respondents: 17% reported an inability to pay for renewal, and 10% reported an unwillingness to pay.
Conclusions: Forgetfulness and unwillingness to insure were the two largest barriers to renewal. Renewal reminders and automatic renewals may thus be highly acceptable and cost-effective interventions to increase population coverage among those willing to insure themselves.
Policy implications:
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- Affordability may not be the major barrier to insurance uptake in Ghana that is it often thought to be.
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- Nudging approaches such as reminders or auto renewal systems may be effective interventions to improve coverage rates.
