Micro Level Analysis on Health Insurance Enrolment among Selected Women in Ghana: Barriers and Predictors
Authors:   University of Education, Winneba. Department of Health Administration and Education, Winneba, Ghana, Boateng Richard 
Published: October 2024

Background: The enrolment onto a health insurance scheme is a viable means of improving access and utilisation of healthcare services which play critical roles in efforts to attain universal health coverage in most countries for which Ghana is inclusive. However, at the micro level, there appears to be inequitable patterns of health insurance enrolment based on gender, and contextual factors. To account for these disparities, the Micro Indicator Cluster Survey (MICS) 2017/2018 was conducted to investigate, inter alia, women enrolment on national health insurance services, and the reasons behind non-enrolment of women in the reproductive ages on health insurance schemes. Thus, this paper explores the barriers and predictors of health insurance enrolment in Ghana using data obtained from a nationality representative micro indicator cluster survey. Methods: Based on health insurance enrolment trajectories, this paper comprehensively investigates the predictors of health insurance enrolment at the micro level among 9,533 women between the ages of 15 years to 49 years in Ghana using data from MICS 2017/2018 which was made available for public access in 2020. Specific items relating to health insurance enrolment which is the independent variable, and contextual and compositions factors were selected in line with relevant literature as predictors to conduct an ordinal logistic regression analysis. Findings: The findings revealed that lack of money or funds, perceived irrelevance of the scheme, relative far proximity to registration centres, and lack of confidence in the operation of health insurance services accounted for the major barriers to non-enrolment. In all, the parameters under wealth index quintile were the most significant predictors of health insurance enrolment in this study. The poorest wealth quintile exhibited the highest odd ratio of 4.655 with lower bound value of 3.873 and an upper bound of 5.595 at p value of <0.001. In sum, the higher odd ratios and statistically significant values in wealth quintile index, education, pregnancy status, and regional location demonstrate the spatial-demographic disparities in enrolment among respondents which lead to exclusion of the most vulnerable in health insurance coverage, and thus, limit the realization of its objective to provide pre-payment arrangement to cater for healthcare cost and reduce financial burden among individuals and households. Conclusion: It is concluded that at the micro level, access to health insurance services is likely to be impeded by system level factors and compositional attributes. There is the need for extensive subscriber segmentation and targeting to help address the challenges of people who are in most need of health insurance services. The national health insurance system should strengthen its pro-poor enrolment incentives and build synergies to derive support from relevant government and non-state actors to improve education and livelihood opportunities for women across the country.