title: Spatial Analysis of Factors Associated with Household Subscription to the National Health Insurance Scheme in Rural Ghana.
abstract: The use of health insurance schemes in financing healthcare delivery and to minimize the poverty gap is gaining considerable recognition among the least developed and resource challenged countries around the world. With the implementation of the socialized health insurance scheme, Ghana has taken the lead in Sub-Saharan Africa and now working out further strategies to gain universal coverage among her citizenry. The primary goal of this study is to explore the spatial relationship between the residential homes and demographic features of the people in the Barekese subdistrict in Ghana on the probability to enroll the entire household unit in the National Health Insurance Scheme (NHIS). Household level data were gathered from 20 communities on the enrollment status into the NHIS alongside demographic and socioeconomic indicators and the spatial location of every household that participated in the study. Kulldorff's purely spatial scan statistic was used to detect geographic clusters of areas with participatory households that have either higher or lower enrollment patterns in the insurance program. Logistic regression models on selected demographic and socioeconomic indicators were built to predict the effect on the odds of enrolling an entire household membership in the NHIS. Three clusters significantly stood out to have either high or low enrollment patterns in the health insurance program taking into accounts the number of households in those sub-zones of the study region. Households in theCluster 1insurance group have very high travel expenses compared to their counterparts in the other idenfied clusters. Travel cost and time to the NHIS registration center to enroll in the program were both significant predictors to participation in the program when controlling for cluster effect. Residents in the High socioeconomic group have about 1.66 [95% CI: 1.27-2.17] times the odds to enroll complete households in the insurance program compared to their counterparts in the Low socioeconomic group. The study demonstrated the use of spatial analytical tools to identify clusters of household enrollment pattern in the NHIS among residents in rural Ghana. In the face of limited resources, policy makers can therefore use the findings as guideline to strategically channel interventions to areas of most need. Furthermore, these analyses can be repeated annually to assess progress on improving insurance coverage.
authors.affiliation: Department of Family and Preventive Medicine, University of Utah , Salt Lake City, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Manortey
authors.affiliation: Department of Family and Preventive Medicine, University of Utah , Salt Lake City, USA.
authors.forename: James
authors.initials: J
authors.lastname: VanDerslice
authors.affiliation: Department of Family and Preventive Medicine, University of Utah , Salt Lake City, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Alder
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health , Piscataway, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Henry
authors.affiliation: Department of Health Sciences, Brigham Young University , Provo, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Crookston
authors.affiliation: Department of Pediatrics, University of Utah , Salt Lake City, USA.
authors.forename: Ty
authors.initials: T
authors.lastname: Dickerson
authors.affiliation: Department of Family and Preventive Medicine, University of Utah , Salt Lake City, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Benson
keywords: Barekuma Collaborative Community Development Project; Bernoulli model; Ghana; National Health Insurance Scheme; Spatial scan statistic