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Table 3 Summary of survey methodology and participant characteristics in the included studies

From: Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review


General Information

Study Characteristics

Participant Characteristics

First Author

Publication Year


Study Objectives/Aims

Study Design

Data Source

Sampling Technique

Recall Period


Study Population


Population Size



Chankova S, Sulzbach S, Diop F. Impact of mutual health organizations: evidence from West Africa. Health Policy and Planning. 2008;23(4):264–276.

To answer the following questions: (1) Do MHOs include vulnerable populations. (2) Do they have an impact on the utilization of curative services. (3) On out-of-pocket expenditures



Twelve months


Three country comparisons; Ghana, Mali, Senegal. (Nkoranza and Offinso districts in Ghana)

SES wealth quintiles, household head, education, occupation, residence(urban-rural), house-hold size

1806 households (34% NHIS, 66% uninsured)



Nguyen HT, Rajkotia Y, Wang H. The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts. International Journal for Equity in Health. 2011, 10: 4–

Not clearly stated but evaluated the impact of NHIS on health service utilization and OOPE(s)


Two-stage cluster & random sampling

Two weeks (injury recall period) to twelve months


Households in two districts (Offinso and Nkoranza) in Ghana

SES wealth quintiles, household head, employment status, house-hold size, ethnicity, residence(urban-rural)

11,617 individuals (35% NHIS, 65% uninsured)



Dalaba M, Akweongo P, Aborigo R, Awine T, Azongo D, Asaana P et al. Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts? Global Health Action. 2014;7(1):23848.

To examine the effect of NHIS in reducing household cost of treating malaria


Convenience random sampling



Households in the Kassena-Nankana district

SES wealth quintiles, age, occupation

4226 households (49.1% NHIS, 50.9% uninsured)



Abrokwah SO, Moser CM, Norton EC. The effect of social health insurance on prenatal care: the case of Ghana. Int J Health Care Finance Econ. 2014;14(4):385–406.

To describe how Ghana’s health insurance scheme affects prenatal care and out-of-pocket expenditures


2° GLS5 2005–2006

Random stratified sampling

Twelve months


Women of child bearing age (15–49 years)

SES wealth quintiles, age, education, region, marital status, occupation, employment status, house-hold size

1032 women from the GLS5 (36% NHIS, 64% uninsured)



Abuosi A, Adzei F, Anarfi J, Badasu D, Atobrah D, Yawson A. Investigating parents/caregivers financial burden of care for children with non-communicable diseases in Ghana. BMC Pediatrics. 2015;15(1).

To assess the extent to which parents/caregivers of children with NCDs experience financial burden in caring for them


Convenience random sampling



Parents/caregivers of children hospitalized with NCDs at hospitals in Greater Accra, Ashanti, and the Volta region

Parents’ age, education, income, marital status, religion, residence (urban-rural)

225 parents/caregivers (87% NHIS 13% uninsured)



Kusi A, Hansen K, Asante F, Enemark U. Does the National Health Insurance Scheme provide financial protection to households in Ghana? BMC Health Services Research. 2015;15(1).

To assess the effect of NHIS on household OOPE(s) and CHE(s)


Random stratified Sampling

Four weeks


Households in three districts in the three ecological zones of Southern (Kwaebibrirem), Middle (Asutifi), and Northern (Savelugu-Nanton)

SES wealth quintiles household size, household head, marital status, residence (urban-rural), education, distance to the nearest facility, mode of transportation

2430 households (28% NHIS, 46% uninsured, & 26% partially insured)



Aryeetey G, Westeneng J, Spaan E, Jehu-Appiah C, Agyepong I, Baltussen R. Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme. International Journal for Equity in Health. 2016;15(1).

To examine whether Ghana’s health insurance scheme reduces OOPE(s), CHE(s) and poverty at the household level


Random stratified sampling

Four weeks


Households in the Eastern and Central Region. Baseline study conducted in 2009 and follow-up in 2011

Household size, marital status, religion, education, residence (urban-rural), occupation, household income, household expenditures

In 2009, 3300 households (31% NHIS 69% uninsured); 2011 3152 households (38% NHIS 62% uninsured)

  1. 1° denotes primary data collection by the authors. 2° is secondary analysis of previously collected data. a Study setting denotes where participants were interviewed
  2. bSES wealth quintile refers to the reporting of wealth-specific results using a principal component analysis of dwelling characteristics, access to utilities and ownership of house-hold items. Further description is available at
  3. cNR not reported by the studies