Billing the Insured: An Assessment of Out-of-Pocket Payment by Insured Patients in Ghana

Billing the Insured: An Assessment of Out-of-Pocket Payment by Insured Patients in Ghana

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Background: The Ghana National Health Insurance Scheme was introduced in 2003 to provide financial protection to the population.While the Scheme has made strides in improving access to healthcare there have been a few challenges including out of pocket charges to insured patients with weak client power.The study investigated the catastrophic nature of the out-of-pocket charges, the factors affecting the charges and the client ngetikin.com power.

Methodology: We used primary data collected in 3 administrative regions: Greater Accra, Ashanti and the Northern regions, within the period April and June 2022 to compute catastrophic expenditure of the out-of-pocket healthcare expenditure on household expenditure on food and non-food.In addition, multivariate logistic regressions and a linear regression were run to examine the incidence of the practice and client power.Results: The results showed that on average the insured paid out-of-pocket charges with a probability of 66%.

The probability was highest (80%) in the Greater Accra, followed by Ashanti region (66.6%) and (52.9%) in the Northern region.

The out-of-pocket charges were found to be catastrophic with incidence rate between 48.2% and 26.1% for the 5% here and 20% thresholds; the overshoots ranged between 34.

1% and 26.9% for the thresholds; the poor were more disadvantaged than the rich.Patients reported the out-of-pocket charges to the NHIA with probability of 1.

9%, but the NHIA did not respond to 81% of the reported cases.Knowledge of the benefit list is likely to motivate the insured to report out-of-pocket charges, while cordial relationship between the NHIA staff and the insured deters providers from charging out-of-pocket.Conclusion: The out-of-pocket charges occur extensively across health facilities and is impoverishing.

A close collaboration between the NHIA and the insured is needed to reduce the incidence and hold providers accountable.