title: Perception of quality of health delivery and health insurance subscription in Ghana.
abstract: National health insurance schemes (NHIS) in developing countries and perhaps in developed countries as well is a considered a pro-poor intervention by helping to bridge the financial burden of access to quality health care. Perceptions of quality of health service could have immense impacts on enrolment. This paper shows how perception of service quality under Ghana's insurance programme contributes to health insurance subscription.
  
  
  
  The study used the 2014 Ghana Demographic and Health Survey (GDHS) dataset. Both descriptive proportions and binary logistic regression techniques were applied to generate results that informed the discussion.
  
  
  
  Our results show that a high proportion of females (33 %) and males (35 %) felt that the quality of health provided to holders of the NHIS card was worse. As a result, approximately 30 % of females and 22%who perceived health care as worse by holding an insurance card did not own an insurance policy. While perceptions of differences in quality among females were significantly different (AOR = 0.453 [95 % CI = 0.375, 0.555], among males, the differences in perceptions of quality of health services under the NHIS were independent in the multivariable analysis. Beyond perceptions of quality, being resident in the Upper West region was an important predictor of health insurance ownership for both males and females.
  
  
  
  For such a social and pro-poor intervention, investing in quality of services to subscribers, especially women who experience enormous health risks in the reproductive period can offer important gains to sustaining the scheme as well as offering affordable health services.
authors.affiliation: African Population and Health Research Centre, Nairobi, Kenya. Joshua.amo-adjei@ucc.edu.gh.|Department of Population and Health, University of Cape Coast, Cape Coast, Ghana. Joshua.amo-adjei@ucc.edu.gh.
authors.forename: Joshua
authors.initials: J
authors.lastname: Amo-Adjei
authors.affiliation: Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
authors.forename: Prince Justin
authors.initials: PJ
authors.lastname: Anku
authors.affiliation: Department of Business Administration, Valley View University, Oyibi, Ghana.
authors.forename: Hannah Fosuah
authors.initials: HF
authors.lastname: Amo
authors.affiliation: Department of Accounting and Finance, University of Cape Coast, Cape Coast, Ghana.
authors.forename: Mavis Osei
authors.initials: MO
authors.lastname: Effah
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards*; D003710:Demography; D005260:Female; D005869:Ghana; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D010067:Ownership; D010465:Perception; D011787:Quality of Health Care / Q000191:economics / Q000592:standards; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Ghana; Health care; Health insurance; Quality; Subscription