title: Do prevailing theories sufficiently explain perceptions and health-seeking behavior of Ghanaians?
abstract: The challenges faced by African countries that have pioneered a national health insurance scheme (NHIS) and the lessons learned can be of great value to other countries, contemplating the introduction of such a health financing system. In 2003, Ghana initiated the NHIS to provide access to healthcare for people in both the formal and informal sectors. The paper assesses the applicability of four theoretical models to explain the perceptions and decisions of Ghanaians to participate in the NHIS. To contextualize these models, we used qualitative data from individual and group interviews of Ghanaians. These interviews form part of the study "towards a client-oriented health insurance system in Ghana" to explain the uptake of the Ghanaian social health insurance. The paper argues for a new integrated model to provide a better understanding of clients' perceptions on illness, healthcare and health insurance. Such a model should highlight trust as a fundamental factor influencing the decision of Ghanaians to enroll in the NHIS.
authors.affiliation: Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands.|Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Fenenga
authors.affiliation: Health Insurance Fund, Amsterdam, The Netherlands.
authors.forename: Kwasi
authors.initials: K
authors.lastname: Boahene
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
authors.forename: Daniel
authors.initials: D
authors.lastname: Arhinful
authors.affiliation: Amsterdam Institute of Global Health and Development, Amsterdam, The Netherlands.
authors.forename: Tobias Rinke
authors.initials: TR
authors.lastname: de Wit
authors.affiliation: Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Hutter
mesh_terms: D001294:Attitude to Health; D003695:Delivery of Health Care; D017144:Focus Groups; D005869:Ghana; D061889:Healthcare Financing; D006801:Humans; D018803:Models, Economic; D008962:Models, Theoretical; D009313:National Health Programs / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D035502:Trust
keywords: Ghana; health insurance; perceptions; theoretical models; trust