title: Malaria care seeking behavior of individuals in Ghana under the NHIS: Are we back to the use of informal care?
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Overall, for malaria care the uninsured are more likely to choose informal care compared to the insured for the treatment of malaria.
authors.affiliation: Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Legon, LG74, Accra, Ghana. amafenny@yahoo.co.uk.
authors.forename: Ama Pokuaa
authors.initials: AP
authors.lastname: Fenny
authors.affiliation: Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Legon, LG74, Accra, Ghana. fasante@ug.edu.gh.
authors.forename: Felix A
authors.initials: FA
authors.lastname: Asante
authors.affiliation: Department of Public Health, Aarhus University, Vennelyst Boulevard 6, 8000, Århus C, Denmark. ue@ph.au.dk.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Enemark
authors.affiliation: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK. Kristian.Hansen@lshtm.ac.uk.
authors.forename: Kristian S
authors.initials: KS
authors.lastname: Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015438:Health Behavior; D005102:Health Expenditures; D006801:Humans; D008288:Malaria / Q000191:economics / Q000628:therapy*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult