Essays on Household Health Expenditures, National Health Insurance and Universal Access to Health Care in Ghana

KWAKYE, EVELYN

Publication:
Essays on Household Health Expenditures, National Health Insurance and Universal Access to Health Care in Ghana

dc.contributor.advisor	Leonce Ndikumana, Ph.D.
dc.contributor.advisor	James Heintz, Ph.D.
dc.contributor.advisor	Gerald Epstein, Ph.D.
dc.contributor.advisor	Mwangi wa Gĩthĩnji, Ph.D.
dc.contributor.author	KWAKYE, EVELYN
dc.contributor.department	University of Massachusetts Amherst
dc.date	2023-09-23 14:30:40
dc.date.accessioned	2024-04-26T16:11:24Z
dc.date.available	2024-04-26T16:11:24Z
dc.date.issued	2016
dc.date.submitted	February
dc.date.submitted	2016
dc.description.abstract	Access to quality health services is essential for maintaining a healthy population and economic development hence the growing global consensus that universal health coverage is necessary. Ghana attempts to expand access by making basic health services free at the point of delivery through its National Health Insurance Scheme (NHIS). Prior studies indicate NHIS increases demand for health services, but questions remain about its impact on out of pocket payments, quality of services, and the financial viability of the program. Hence, this dissertation analyzes the financial risk in health care seeking, the effect of NHIS on out of pocket payments and access to quality health care, and the financial viability of NHIS compared with the outcomes of Rwanda’s community-based health insurance programs with similar objectives but different approaches. The empirical analyses uses data from the Ghana Living Standards Survey conducted in 2005-2006 covering 37,212 individuals in 8,868 households, data from the 2008 Ghana Demographic and Health Survey V covering 9919 respondents aged 15-49 years, and data logging from other sources. The methods include two-stage multivariate regression modelling and maximum likelihood estimations. The study finds health expenditures respond strongly to need and weakly to income, the poor are more likely than the rich to pay of pocket for health care, and catastrophic out of pocket payments occur in all income groups and significantly among the poor. The need for uninsured services and ability to pay significantly determine of out of pocket payments by the insured. These findings imply that NHIS expands access to desired health services for the better-offs but does not eliminate catastrophic out of pocket payments, especially for the poor. Attitude of health worker, rather than the technical effectiveness of services, significantly predicts dissatisfaction with quality. The Rwandan model is more equitable than NHIS, but NHIS spends ten times more per capita. Drawing from Ghana’s and Rwanda’s experience, effective strategies for national health insurance programs must include i) practical means-testing in setting insurance premiums to improve equity ii) mandatory enrollments by whole households as a strategy for financial sustainability iii) client-based performance-evaluation in provider reimbursements to improve client satisfaction.
dc.description.degree	Doctor of Philosophy (PhD)
dc.description.department	Economics
dc.identifier.doi	https://doi.org/10.7275/7946812.0
dc.identifier.orcid	N/A
dc.identifier.uri	https://hdl.handle.net/20.500.14394/19814
dc.relation.url	https://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1619&context=dissertations_2&unstamped=1
dc.source.status	published
dc.subject	universal health coverage
dc.subject	household expenditures
dc.subject	Ghana NHIS
dc.subject	Rwanda CBHI
dc.subject	catastrophic out of pocket payments
dc.subject	Growth and Development
dc.subject	Health Economics
dc.subject	Health Services Administration
dc.subject	Health Services Research
dc.subject	Income Distribution
dc.subject	Insurance
dc.subject	Public Economics
dc.subject	Public Health Education and Promotion
dc.title	Essays on Household Health Expenditures, National Health Insurance and Universal Access to Health Care in Ghana
dc.type	openaccess
dc.type	dissertation
digcom.contributor.author	isAuthorOfPublication\|email:evelynkwakye@ymail.com\|institution:University of Massachusetts Amherst\|KWAKYE, EVELYN
digcom.identifier	dissertations_2/585
digcom.identifier.contextkey	7946812
digcom.identifier.submissionpath	dissertations_2/585
dspace.entity.type	Publication