title: Investigating parents/caregivers financial burden of care for children with non-communicable diseases in Ghana.
abstract: BACKGROUND
  The introduction of the Ghana national health insurance scheme (NHIS) has led to progressive and significant increase in utilization of health services. However, the financial burden of caring for children with non-communicable diseases (NCDs) under the dispensation of the NHIS, especially during hospitalization, is less researched. This paper therefore sought to assess the financial burden parents/caregivers face in caring for children hospitalized with NCDs in Ghana, in the era of the Ghana NHIS.
  
  
  METHODS
  We conducted a cross-sectional survey of 225 parents or caregivers of children with NCDS hospitalized in three hospitals. Convenience sampling was used to select those whose children were discharged from hospital after hospitalization. Descriptive statistics such as frequencies and chi-square and logistic regression were used in data analysis. The main outcome variable was financial burden of care, proxied by cost of hospitalization. The independent variable included socio-economic and other indicators such as age, sex, income levels and financial difficulties faced by parents/caregivers.
  
  
  RESULTS
  The study found that over 30 % of parents/caregivers spend more than Gh¢50 (25$) as cost of treatment of children hospitalized with NCDs; and over 40 % of parents/caregivers also face financial difficulties in providing health care to their wards. It was also found that even though many children hospitalized with NCDs have been covered by the NHIS, and that the NHIS indeed, provides significant financial relief to parents in the care of children with NCDs, children who are insured still pay out-of-pocket for health care, in spite of their insurance status. It was also found that there is less support from relatives and friends in the care of children hospitalized with NCDs, thus exacerbating parents/caregivers financial burden of caring for the children.
  
  
  CONCLUSIONS
  Even though health insurance has proven to be of significant relief to the financial burden of caring for children with NCDs, parents/caregivers still face significant financial burden in the care of their wards. Stakeholders in health care delivery should therefore ensure that all children with NCDs including those excluded from the NHIS should be covered by NHIS. A special effort focusing on identifying children with NCDs within the lower income groups, especially from rural areas, in order to exempt them from any form of payment for their health care is recommended.
authors.affiliation: Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana. aabuosi@ug.edu.gh.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Abuosi
authors.affiliation: Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana. fadzei@ug.edu.gh.
authors.forename: Francis A
authors.initials: FA
authors.lastname: Adzei
authors.affiliation: Regional Institute of Population Studies, University of Ghana, Legon, Ghana. jkanarfi@ug.edu.gh.
authors.forename: John
authors.initials: J
authors.lastname: Anarfi
authors.affiliation: Regional Institute of Population Studies, University of Ghana, Legon, Ghana. delalibadasu@yahoo.com.
authors.forename: Delali M
authors.initials: DM
authors.lastname: Badasu
authors.affiliation: Institute of African Studies, University of Ghana, Legon, Ghana. akleh30@yahoo.com.
authors.forename: Deborah
authors.initials: D
authors.lastname: Atobrah
authors.affiliation: Department of Community Health, University of Ghana Medical School, Korle Bu, Ghana. aeyawson@yahoo.com.
authors.forename: Alfred
authors.initials: A
authors.lastname: Yawson
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000191:economics*; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010290:Parents; D011203:Poverty; D012959:Socioeconomic Factors; D055815:Young Adult