Paul Shultz - Distributional Consequences of the Ghana National Health Insurance Scheme: Income and Price Elasticities of Demand for Health Insurance

National health insurance is one means to provide health care. This paper describes the financing and receipt of the Ghana National Health Insurance Scheme (NHIS) implemented in 2005. To distinguish those who register and are expected to benefit from the NHIS, and what reforms might broaden health care coverage, a 2009 representative Ghana Socio-Economic Panel Survey (GSEPS) is studied to determine program registration and current coverage. They are explained by district average prepayment fees for insurance, demographic groups exempted from such fees, the distance from households to NHIS registration offices and medical facilities, household consumption, individual schooling, and gender. Although the NHIS legislation indicates that insurance fees are to increase with an individual’s “ability to pay”, they do not appear to increase regularly with adult education or household consumption. Not surprisingly, higher district prices discourage take up, whereas more then 80 percent of the cost of the insurance is covered by a 2.5% value added tax on consumption and central government financing. Households with greater consumption and individuals with above average schooling are more likely to be registered and covered. The policy implications of these empirical regularities are explored in the paper, and the limitations of the observational evidence for evaluating the program are discussed in the conclusion. # 4834