title: Factors influencing the decision to drop out of health insurance enrolment among urban slum dwellers in Ghana.
abstract: OBJECTIVE
  To identify the factors influencing dropout from Ghana's health insurance scheme among populations living in slum communities.
  
  
  METHODS
  Cross-sectional data were collected from residents of 22 slums in the Accra Metropolitan Assembly. Cluster and systematic random sampling techniques were used to select and interview 600 individuals who had dropped out from the scheme 6 months prior to the study. Descriptive statistics and multivariate logistic regression models were computed to account for sample characteristics and reasons associated with the decision to dropout.
  
  
  RESULTS
  The proportion of dropouts in the sample increased from the range of 6.8% in 2008 to 34.8% in 2012. Non-affordability of premium was the predominant reason followed by rare illness episodes, limited benefits of the scheme and poor service quality. Low-income earners and those with low education were significantly more likely to report premium non-affordability. Rare illness was a common reason among younger respondents, informal sector workers and respondents with higher education. All subgroups of age, education, occupation and income reported nominal benefits of the scheme as a reason for dropout.
  
  
  CONCLUSIONS
  Interventions targeted at removing bottlenecks to health insurance enrolment are salient to maximising the size of the insurance pool. Strengthening service quality and extending the premium exemption to cover low-income families in slum communities is a valuable strategy to achieve universal health coverage.
authors.affiliation: Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Atinga
authors.forename: Gilbert Abotisem
authors.initials: GA
authors.lastname: Abiiro
authors.forename: Robert Bella
authors.initials: RB
authors.lastname: Kuganab-Lem
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D011204:Poverty Areas; D025341:Principal Component Analysis; D012307:Risk Factors; D012959:Socioeconomic Factors; D014504:Urban Health / Q000191:economics / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Ghana; abandono; appartenance; assurance santé; bidonville; dropout; désistement; health insurance; membership; miembros; seguro de salud; slum; tugurio