Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?

TY - JOUR

T1 - Malaria care seeking behavior of individuals in Ghana under the NHIS

T2 - Are we back to the use of informal care?

AU - Fenny, Ama Pokuaa

AU - Asante, Felix A

AU - Enemark, Ulrika

AU - Hansen, Kristian S

PY - 2015/4/12

Y1 - 2015/4/12

N2 - BACKGROUND: Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy.METHOD: Using a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study.RESULTS: Out of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities.CONCLUSION: Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.

AB - BACKGROUND: Malaria is Ghana's most endemic disease; occurring across most parts of the country with a significant impact on individuals and the health system as whole. Treatment seeking for malaria care takes various forms. The National Health Insurance Scheme (NHIS) was introduced in 2004 to promote access to health services to mitigate the negative impact of the user fee regime. Ten years on, national coverage is less than 40% of the total population and patients continue to make direct payments for health services. This paper analyses the care-seeking behaviour of households for treatment of malaria in Ghana under the NHI policy.METHOD: Using a cross-sectional survey of household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah, a multinomial logit model is estimated. The sample consists of 365 adults and children reporting being ill with malaria in the last four weeks prior to the study.RESULTS: Out of the total, 58% were insured and 71% of them sought care from a formal health facility. Among the insured, 15% chose informal care compared to 48% among the uninsured. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. The results show that the insured are 6 times more likely to choose regional/district hospitals: 5 times more likely to choose health centres/clinics and 7 times more likely to choose private hospitals/clinics over informal care when compared with the uninsured. Individual characteristics such as age, education and wealth status were significant determinants of health care provider choice for specific categories of health facilities.CONCLUSION: Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Aged

KW - Child

KW - Child, Preschool

KW - Choice Behavior

KW - Cross-Sectional Studies

KW - Delivery of Health Care

KW - Female

KW - Ghana

KW - Health Behavior

KW - Health Expenditures

KW - Humans

KW - Malaria

KW - Male

KW - Medically Uninsured

KW - Middle Aged

KW - National Health Programs

KW - Patient Acceptance of Health Care

KW - Socioeconomic Factors

KW - Young Adult

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1186/s12889-015-1696-3

DO - 10.1186/s12889-015-1696-3

M3 - Journal article

C2 - 25884362

SN - 1471-2458

VL - 15

SP - 1

EP - 8

JO - BMC Public Health

JF - BMC Public Health

M1 - 370

ER -