Factors associated with health insurance enrolment among ghanaian children under the five years. Analysis of secondary data from a national survey

BMC Health Services Research, Volume 22, No. 1, Year 2022

Interprétation

Background: Health insurance enrolment provides financial access to health care and reduces the risk of catastrophic healthcare expenditure. Therefore, the objective of this study was to assess the prevalence and correlates of health insurance enrolment among Ghanaian children under five years. Methods: We analysed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. The survey was a nationally representative weighted sample comprising 8,874 children under five years and employed Computer Assisted Personal Interviewing to collect data from the participants. In addition, Chi-square and Logistic Regression analyses were conducted to determine factors associated with health insurance enrolment. Results: The results showed that a majority (58.4%) of the participants were insured. Health insurance enrollment was associated with child age, maternal educational status, wealth index, place of residence and geographical region (p < 0.05). Children born to mothers with higher educational status (AOR = 2.14; 95% CI: 1.39–3.30) and mothers in the richest wealth quintile (AOR = 2.82; 95% CI: 2.00–3.98) had a higher likelihood of being insured compared with their counterparts. Also, children residing in rural areas (AOR = 0.75; 95% CI: 0.61–0.91) were less likely to be insured than children in urban areas. Conclusion: This study revealed that more than half of the participants were insured. Health insurance enrolment was influenced by the child's age, mother's educational status, wealth index, residence, ethnicity and geographical region. Therefore, interventions aimed at increasing health insurance coverage among children should focus on children from low socio-economic backgrounds. Stakeholders can leverage these findings to help improve health insurance coverage among Ghanaian children under five years. In this study, we analysed the 2017/2018 Ghana MICS [27]. The 2017/18 MICS collected demographic and health data across Ghana, including rural and urban settings. The sampling of participants was done in two phases. The first phase involved selecting 660 enumeration areas from 20 strata, proportional to size. The second involved the selection of 13,202 households within the selected enumeration areas. The weighted sample size of children under five years was 8,874. Ghana had ten administrative regions divided into 20 strata, of which ten are rural and ten are urban. Participants were selected across all the regions and strata. The inclusion criteria were under five children in the selected households or those who passed the night before the survey in the selected households. Data were collected using Computer Assisted Personal Interviewing (CAPI). The under five questionnaire was administered to caregivers of children below five years. Trained field officers and supervisors collected the data between October 2017 and September 2018. Details about the 2017/18 MICS are provided elsewhere [28]. The dependent variable in this study was health insurance status (i.e. is [name] covered by any health insurance?) coded as 1 = Yes and 0 = No. The independent variables identified in the literature included child and maternal characteristics. These include child’s age, maternal educational status, wealth index, ethnicity, geographic region and place of residence. Details about the coding are provided in Table 1. The complex nature of the survey was accounted for by employing the ‘svy’ STATA command. STATA/SE version 16 (StataCorp, College Station, Texas, USA) was used to analyse that data. Descriptive statistics were computed for participants’ characteristics and summarized in a table. The Chi-square test was employed to examine the association between participant characteristics and health insurance status at the bivariate level. Binary Logistic Regression was employed to identify significant predictors of health insurance enrolment among under five children. The results were reported at a 95% confidence level. Socio-demographic characteristics of children, mothers and health insurance status in Ghana, 2017/18 Male Female 4369 4505 49.2 50.8 0–11 12–23 24–35 36–47 48–59 1700 1694 1750 1928 1802 19.2 19.1 19.7 21.7 20.3 Pre-primary/none Primary Junior High School Senior High School Higher 2428 1790 3259 954 443 27.3 20.2 36.7 10.8 5 Poorest Second Middle Fourth Richest 1966 1834 1769 1676 1630 22.2 20.7 19.9 18.8 18.4 Urban Rural 3821 5053 43.1 56.9 Western Central Greater Accra Volta Eastern Ashanti Brong- Ahafo Northern Upper East Upper West 931 926 862 710 953 2111 833 1055 282 211 10.5 10.4 9.7 8 10.7 23.8 9.4 11.9 3.2 2.4 Akan Mole Dagbani Others (Ewe, Gruma etc.) 4091 1503 3280 46.1 16.9 37 Insured Non-insured 5186 3689 58.4 41.6

Résumé de l’IA

Study Justification:

This study aimed to assess the prevalence and factors associated with health insurance enrollment among Ghanaian children under five years. Health insurance enrollment provides financial access to healthcare and reduces the risk of catastrophic healthcare expenditure. Understanding the factors influencing enrollment can help policymakers and stakeholders develop targeted interventions to improve health insurance coverage among this population.

Highlights:

– The study analyzed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey, which included a nationally representative sample of 8,874 children under five years.
– The majority (58.4%) of the participants were insured, indicating a relatively high level of health insurance coverage among Ghanaian children.
– Factors associated with health insurance enrollment included child age, maternal educational status, wealth index, place of residence, and geographical region.
– Children born to mothers with higher educational status and those in the richest wealth quintile had a higher likelihood of being insured.
– Children residing in rural areas were less likely to be insured compared to those in urban areas.
– The study recommends that interventions aimed at increasing health insurance coverage among children should focus on children from low socio-economic backgrounds.

Recommendations for Lay Reader and Policy Maker:

– Policymakers should prioritize interventions that target children from low socio-economic backgrounds to improve health insurance coverage.
– Efforts should be made to increase awareness and accessibility of health insurance options in rural areas.
– Investing in education and improving maternal educational status can positively impact health insurance enrollment among children.
– Stakeholders should collaborate to develop and implement strategies that address the identified factors influencing health insurance enrollment.

Key Role Players:

– Ministry of Health: Responsible for policy development and implementation of health insurance programs.
– National Health Insurance Authority: Oversees the administration and management of health insurance schemes.
– Non-Governmental Organizations (NGOs): Can play a role in raising awareness and providing support for health insurance enrollment.
– Community Health Workers: Can help educate and assist families in enrolling their children in health insurance programs.
– Health Insurance Providers: Should collaborate with policymakers and stakeholders to develop affordable and accessible insurance options for children.

Cost Items for Planning Recommendations:

– Public Awareness Campaigns: Budget for advertising, community outreach, and educational materials to increase awareness of health insurance options.
– Training and Capacity Building: Allocate funds for training community health workers and healthcare providers on health insurance enrollment processes.
– Infrastructure Development: Invest in improving healthcare infrastructure in rural areas to enhance access to health insurance services.
– Subsidies and Financial Support: Consider budgeting for subsidies or financial assistance programs to make health insurance more affordable for low-income families.
– Monitoring and Evaluation: Allocate resources for monitoring and evaluating the impact of interventions on health insurance enrollment among children.
Please note that the cost items provided are general suggestions and may vary based on the specific context and resources available in Ghana.

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized a nationally representative weighted sample and employed statistical analyses to determine factors associated with health insurance enrollment among Ghanaian children under five years. The study provides specific findings regarding the prevalence and correlates of health insurance enrollment. However, the abstract does not provide detailed information about the methodology used, such as the specific statistical tests employed or the control variables included in the logistic regression analysis. To improve the strength of the evidence, the abstract could include more information about the methodology, including a clear description of the statistical analyses conducted and the inclusion of relevant control variables. Additionally, the abstract could provide more context about the limitations of the study and potential implications of the findings.

Abstrait

In this study, we analysed the 2017/2018 Ghana MICS [27]. The 2017/18 MICS collected demographic and health data across Ghana, including rural and urban settings. The sampling of participants was done in two phases. The first phase involved selecting 660 enumeration areas from 20 strata, proportional to size. The second involved the selection of 13,202 households within the selected enumeration areas. The weighted sample size of children under five years was 8,874. Ghana had ten administrative regions divided into 20 strata, of which ten are rural and ten are urban. Participants were selected across all the regions and strata. The inclusion criteria were under five children in the selected households or those who passed the night before the survey in the selected households. Data were collected using Computer Assisted Personal Interviewing (CAPI). The under five questionnaire was administered to caregivers of children below five years. Trained field officers and supervisors collected the data between October 2017 and September 2018. Details about the 2017/18 MICS are provided elsewhere [28]. The dependent variable in this study was health insurance status (i.e. is [name] covered by any health insurance?) coded as 1 = Yes and 0 = No. The independent variables identified in the literature included child and maternal characteristics. These include child’s age, maternal educational status, wealth index, ethnicity, geographic region and place of residence. Details about the coding are provided in Table 1. The complex nature of the survey was accounted for by employing the ‘svy’ STATA command. STATA/SE version 16 (StataCorp, College Station, Texas, USA) was used to analyse that data. Descriptive statistics were computed for participants’ characteristics and summarized in a table. The Chi-square test was employed to examine the association between participant characteristics and health insurance status at the bivariate level. Binary Logistic Regression was employed to identify significant predictors of health insurance enrolment among under five children. The results were reported at a 95% confidence level. Socio-demographic characteristics of children, mothers and health insurance status in Ghana, 2017/18 Male Female 4369 4505 49.2 50.8 0–11 12–23 24–35 36–47 48–59 1700 1694 1750 1928 1802 19.2 19.1 19.7 21.7 20.3 Pre-primary/none Primary Junior High School Senior High School Higher 2428 1790 3259 954 443 27.3 20.2 36.7 10.8 5 Poorest Second Middle Fourth Richest 1966 1834 1769 1676 1630 22.2 20.7 19.9 18.8 18.4 Urban Rural 3821 5053 43.1 56.9 Western Central Greater Accra Volta Eastern Ashanti Brong- Ahafo Northern Upper East Upper West 931 926 862 710 953 2111 833 1055 282 211 10.5 10.4 9.7 8 10.7 23.8 9.4 11.9 3.2 2.4 Akan Mole Dagbani Others (Ewe, Gruma etc.) 4091 1503 3280 46.1 16.9 37 Insured Non-insured 5186 3689 58.4 41.6

Matériaux

N/A

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and resources related to maternal health, such as prenatal care, nutrition, and postpartum care. These apps can be easily accessible to pregnant women and new mothers, even in remote areas, and can provide personalized guidance and reminders.

2. Telemedicine Services: Implement telemedicine services that allow pregnant women to consult with healthcare professionals remotely. This can help overcome geographical barriers and provide access to medical advice and support, especially in areas with limited healthcare facilities.

3. Community Health Workers: Train and deploy community health workers who can provide basic maternal health services, education, and support in underserved areas. These workers can conduct home visits, provide antenatal and postnatal care, and refer women to appropriate healthcare facilities when needed.

4. Maternal Health Vouchers: Introduce voucher programs that provide financial assistance to pregnant women, enabling them to access essential maternal health services. These vouchers can cover costs for prenatal care, delivery, and postpartum care, ensuring that women receive the necessary care without facing financial barriers.

5. Public-Private Partnerships: Foster collaborations between public and private sectors to improve access to maternal health services. This can involve partnering with private healthcare providers to expand service coverage, improve infrastructure, and enhance the quality of care.

6. Maternal Health Education Campaigns: Launch targeted education campaigns to raise awareness about the importance of maternal health and the available services. These campaigns can be conducted through various channels, including mass media, community outreach programs, and social media platforms.

7. Maternal Health Clinics: Establish specialized maternal health clinics that provide comprehensive care for pregnant women and new mothers. These clinics can offer a range of services, including prenatal check-ups, childbirth classes, breastfeeding support, and postpartum care.

8. Transportation Support: Develop transportation initiatives that address the challenge of accessing healthcare facilities in remote areas. This can involve providing transportation vouchers, organizing community transport services, or partnering with ride-sharing companies to offer discounted or free rides to pregnant women.

9. Maternal Health Hotlines: Set up dedicated hotlines or helplines that pregnant women can call to seek advice, ask questions, and receive guidance on maternal health issues. Trained professionals can provide information, referrals, and support over the phone.

10. Maternal Health Monitoring Systems: Implement digital systems for monitoring and tracking maternal health indicators, such as prenatal visits, immunizations, and postpartum check-ups. These systems can help identify gaps in care, ensure timely interventions, and improve overall maternal health outcomes.

It’s important to note that the specific implementation and effectiveness of these innovations may vary depending on the local context and resources available.

AI Innovations Description

Based on the analysis of the secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey, the following recommendations can be made to improve access to maternal health:

1. Increase awareness and education: Implement targeted campaigns and educational programs to raise awareness about the importance of health insurance for maternal health. This can include providing information about the benefits of health insurance, how to enroll, and the available options.

2. Improve accessibility: Ensure that health insurance enrollment processes are easily accessible to all pregnant women and new mothers. This can be done by setting up enrollment centers in healthcare facilities, community centers, and other convenient locations. Additionally, provide support and guidance to help women navigate the enrollment process.

3. Address socio-economic barriers: Develop strategies to address socio-economic barriers that may prevent women from enrolling in health insurance. This can include providing subsidies or financial assistance to low-income women, as well as implementing policies to reduce out-of-pocket expenses for maternal healthcare services.

4. Strengthen healthcare infrastructure: Invest in improving healthcare infrastructure, particularly in rural areas, to ensure that quality maternal healthcare services are available and accessible to all women. This can include building and equipping healthcare facilities, training healthcare providers, and improving transportation systems to facilitate access to healthcare.

5. Collaborate with stakeholders: Engage with relevant stakeholders, including government agencies, non-governmental organizations, and community leaders, to develop and implement comprehensive strategies to improve access to maternal health. This can involve partnerships to increase funding, share resources, and coordinate efforts to address the barriers to health insurance enrollment.

By implementing these recommendations, it is possible to improve access to maternal health and ensure that more women have the financial means to access the necessary healthcare services during pregnancy and childbirth.

AI Innovations Methodology

Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement campaigns and programs to educate pregnant women and their families about the importance of maternal health and the available resources and services.

2. Improve healthcare infrastructure: Invest in the development and improvement of healthcare facilities, especially in rural areas, to ensure that pregnant women have access to quality maternal healthcare services.

3. Strengthen health insurance coverage: Expand health insurance coverage to include comprehensive maternal health services, making it more affordable and accessible for pregnant women.

4. Enhance transportation services: Improve transportation infrastructure and services to ensure that pregnant women can easily access healthcare facilities, especially in remote areas.

5. Train and deploy more healthcare professionals: Increase the number of skilled healthcare professionals, such as midwives and obstetricians, and ensure their deployment in areas with limited access to maternal healthcare.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that measure access to maternal health, such as the percentage of pregnant women receiving prenatal care, the percentage of births attended by skilled healthcare professionals, and the percentage of women with health insurance coverage for maternal healthcare.

2. Collect baseline data: Gather data on the current status of these indicators to establish a baseline for comparison.

3. Implement the recommendations: Introduce the recommended interventions and initiatives to improve access to maternal health, such as awareness campaigns, infrastructure improvements, and healthcare workforce expansion.

4. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on the selected indicators to measure progress.

5. Analyze the data: Use statistical analysis techniques to compare the baseline data with the data collected after implementing the recommendations. This analysis will help determine the impact of the interventions on improving access to maternal health.

6. Evaluate the results: Assess the findings of the analysis to determine the effectiveness of the recommendations in improving access to maternal health. Identify any gaps or areas that require further intervention.

7. Adjust and refine: Based on the evaluation results, make adjustments and refinements to the recommendations to optimize their impact on improving access to maternal health.

By following this methodology, stakeholders can gain insights into the potential impact of the recommendations and make informed decisions on how to allocate resources and prioritize interventions to improve access to maternal health.

Auteurs et co-auteurs

Statistics:

Citations: 1

Authors: 4

Identifiers:

DOI: 10.1186/s12913-022-07670-7

Research Areas:

Community Interventions, Disparities, Health System and Policy, Maternal Access, Maternal and Child Health

Study Countries:

Ghana

Study Design:

Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Male & Female

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