Who pays for malaria treatment in Ghana in the era of Health Insurance Policy?

A Poster Presentation at the 61st Annual Meeting of the American Society of Tropical Medicine and Hygiene, 11-15 November 2012, Atlanta for the Young Investigators Award Competition.

Alexander A. Nartey1, Patricia Akweongo2, Jonas Akpakli1, Elizabeth Awini1, Annshirley A. Appiatse1, Gabriel Odonkor1, Martin Ajuik3, Moses Aikins4, Margaret Gyapong1 – 1Dodowa Health Research Centre, Accra, Ghana, 2School of public Health, University of Ghana, Accra, Ghana, 3INDEPTH Network, Accra, Ghana, 4School of Public Health, University of Ghana, Accra, Ghana

dscn0479-sm.jpgHealth insurance was instituted in 2005 as national policy by the government of Ghana to replace the cash and carry system of health care payment. This major financing reform in Ghana is a pro-poor intervention aimed at meeting basic health care needs of Ghanaians, with exemptions for vulnerable groups like children under five, pregnant women, and the aged. In recent years the out-of-pocket payments in national health insurance accredited health delivery facilities is rising. The paper investigates payment mechanisms households seeking treatment for malaria in Ghana use. It also assesses the socio-economic differentials among those using health insurance as a cushion for health care costs.

The study is a cross sectional cost-of-illness study under the INDEPTH Network Effectiveness Safety Studies which employed quantitative data from the Dodowa Health and Demographic Surveillance System (HDSS) from October 2009 to December 2011. A household member who had been treated of fever within the last two weeks was interviewed about their expenditure on the treatment and the mechanism used to pay for the treatment.

A total of 540 household members who received malaria treatment within the past two weeks were interviewed. Over 76% of household members paid out-of-pocket for treatment they received whereas 22% used health insurance and the remaining paid through an employer. An average of $33 (¢50.5) was borrowed by some patients to meet the health care cost.

payment-cash-or-nhis-sm.jpgA bivariate analysis indicated that the poorest households are 90% more likely to pay out-of-pocket than the least poor (67%) for seeking malaria treatment. The analysis also showed that only 5% of the poorest patients are likely to use health insurance whiles the least poor are likely to use 42% of time, their health Insurance to pay for treatment.

Out-of-pocket payments for health care are still significant component of health care costs in Ghana despite the fact that the national health insurance is in operation. The poorest patients continue to suffer the burden of malaria treatment expenses and borrow to pay out-of-pocket for care.

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