Examining equity in health insurance coverage: an analysis of Ghana’s National Health Insurance Scheme

BACKGROUND: Following years of out-of-pocket payment for healthcare, some countries in Africa including Ghana, Kenya and Rwanda have instituted social health protection programs through health insurance to provide access to quality and affordable healthcare especially for the poor. This paper examines equity in coverage under Ghana's National Health Insurance Scheme (NHIS). METHODS: Secondary data from the 2008 Ghana Demographic and Health Survey based on an analytical sample of 4821 females (15-49 years) and 4568 males (15-59 years) were analysed using descriptive, bivariate and multivariate methods. Concentration curves and indices were used to examine equity in coverage on the NHIS. RESULTS: As at 2008, more than 60% of Ghanaians aged 15-59 years were not covered under the NHIS with slightly more females (38.9%) than males (29.7%) covered. Coverage was highest among the highly educated, professionals, those from households in the richest wealth quintile and urban residents. Lack of coverage was most concentrated among the poor. CONCLUSIONS: Universal coverage under the NHIS is far from being achieved with marked exclusion of the poor. There is the need for deliberate action to enrol the poor under the NHIS.