Does the National Health Insurance Scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?
BACKGROUND
The Government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to replace out-of-pocket (OOP) payment for health services with the inherent aim of reducing the direct cost of treating illness to households.


OBJECTIVE
To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana.


METHODS
We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective.


RESULTS
Of the 4,226 households visited, a total of 1,324 (31%) household members reported fever and 51% (675) reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424), with the remainder either self-medicating with drugs from chemical shops 32% (217) or with leftover drugs or herbs 5% (34). Most of those who sought care from formal health facilities were insured 79% (334). The average direct medical cost of treating malaria was GH¢3.2 (US$2.1) per case with the insured spending less (GH¢2.6/US$1.7) per case than the uninsured (GH¢3.2/US$2.1). The overall average cost (direct and indirect) incurred by households per malaria treatment was GH¢20.9 (US$13.9). Though the insured accounted for a larger proportion of admissions at health facilities 76% (31) than the uninsured 24% (10), the average amount households spent on the insured was less (GH¢4/US$2.7) than their uninsured counterparts (GH¢6.4/US$4.3). The difference was not statistically significant (p=0.2330).


CONCLUSIONS
Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect on cost (outpatient and in-patient) of malaria treatment.
Navrongo Health Research Centre, Navrongo, Ghana; madalaba@yahoo.com.
Maxwell
M
Ayindenaba Dalaba
School of Public Health, University of Ghana, Accra, Ghana.
Patricia
P
Akweongo
Navrongo Health Research Centre, Navrongo, Ghana; Global Public Health, Monash University, Malaysia.
Raymond
R
Aborigo
Navrongo Health Research Centre, Navrongo, Ghana.
Timothy
T
Awine
Navrongo Health Research Centre, Navrongo, Ghana.
Daniel
D
Kweku Azongo
Navrongo Health Research Centre, Navrongo, Ghana.
Prosper
P
Asaana
Navrongo Health Research Centre, Navrongo, Ghana.
Frank
F
Atuguba
Navrongo Health Research Centre, Navrongo, Ghana.
Abraham
A
Oduro
D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000191:economics; D017046:Cost Savings / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005869:Ghana / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000188:drug therapy / Q000191:economics*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data; D011159:Population Surveillance; D055815:Young Adult
D000962:Antimalarials
Ghana; Kassena-Nankana district; cost; malaria; national health insurance; treatment seeking