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Table 4 Summary of Statistical Analysis and Outcomes Reported by 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

Outcomes

Statistical Analysis

First Author

Publication Year

Citation/Title

Outcomes measured

Measures of financial risk protection

Reduction in out of pocket expenditure (OOPE)

Reduction in catastrophic health expenditure (CHE)

Poverty reduction

Type of statistical analysis

Logistic regression (N) number of variables

Key findings

Chankova

2008

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

Direct OOPE(s) for inpatient, outpatient care, & transportation cost

NR1

OPD3 NS2

Transportation NS2 IPD OOPE***

(NHIS $4.25USD, uninsured $43.88USD)

NR1

NR1

Descriptive statistics, logistic regression

(8) Independent variables, dependent variable (OOPE)

1.) Insurance was associated with lower out of pocket payments for inpatient care.

2.) No significance difference in outpatient care.

3.) No difference in transportation cost

Nguyen

2011

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–https://doi.org/10.1186/1475-9276-10-4.

OOPE(s) & CHE(s) for illness, surgery, ANC & inpatient care

4 indicators of CHE(s); (5% & 10% of individual income) and (10% & 20% of SE(s)5

OOPE*** NHIS 21000 GH¢ ($2.3 USD), uninsured 30,000 GH¢ ($ 3.2 USD)

NHIS reduced CHE(s) by 0.5 to 1% depending on the threshold used.

NR1

Descriptive statistics, logistic regression

(6) Independent variables, dependent variable (OOPE)

NHIS reduces the probability of incurring CHE(s).

Dalaba

2014

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.

Direct OOPE(s) for malaria treatment, lost wages & transportation cost

NR1

NS2

NR1

NR1

Descriptive statistics

NR1

1.) NHIS has some protective effect on cost of malaria treatment, however not statistically significant

2.) Indirect costs of treating malaria were three times higher than direct costs for both insured and uninsured households.

Abrokwah

2014

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.

Prenatal care utilization & OOPE(s) per ANC visit

NR1

OOPE*** NHIS 3600GH¢ ($0.40 USD), uninsured 21,000 GH¢ ($2.40 USD) for the first ANC visit

NR1

NR1

Descriptive statistics, logistic regression

(7) Independent variables, dependent variable (prenatal OOPE)

1.) Insured women spend less on prenatal care compared to the uninsured.

2.) Having insurance increases the number of prenatal care visits by 24% relative to being uninsured.

Abuosi

2015

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).

Financial burden/ OOPE direct inpatient care & perceived financial difficulties

NR1 used an arbitrary threshold of > 50 GH¢. as expensive or burdensome

NR1

NR1

NR1

Descriptive, logistic regression

(11) Independent variables, dependent variable (financial burden of care)

Uninsured respondents were twenty- three times more likely than the insured to make higher out of pocket payments for hospitalizations and more likely to experience financial burden of care.

Kusi

2015

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).

Direct OOPE(s) for inpatient, outpatient care, & transportation cost

10% of total household expenditures & SE(s)5 at (20% & 40% thresholds)

OOPE*** OPD3; NHIS 6.7 GH¢ uninsured 25.5GH¢. IPD4*** NHIS 44.25GH¢ uninsured 86.73 GH¢. Transportation cost NS2

6% of NHIS respondents compared to 23.2% of the uninsured made CHE(s)

NR1

Descriptive statistics, logistic regression

(6) Independent variables, dependent variable (CHE)

1.) NHIS significantly reduces the probability of a household incurring CHE(s).

2.) Households with at least one member having a chronic illness were 94% higher than those without a chronic illness to incur CHE.

Aryeetey

2016

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).

Direct OOPE(s) for inpatient, outpatient care, & transportation cost

SE(s)5 at (40% threshold)

IPD4 NS2 2009 OOPE ***OPD3 NHIS GH¢ 19.8 uninsured GH¢ 27.4. 2011 OOPE*** OPD3 NHIS 26.1GH¢ uninsured 53.2GH¢. Transportation cost NR1

In 2009, 18.4% of NHIS respondents made CHE(s), compared to 36.1% uninsured. In 2011 7.1% NHIS & 28.7% Uninsured

NHIS households were 7.5% less likely to fall into poverty.

Descriptive statistics, logistic regression

(9) Independent variable Insurance status, dependent variable (OOPE)

1.) Enrolment in health insurance reduced household OOPE by 86%.

2.) Insured households were 3% less likely to make CHE(s).

3.) Being insured reduces households’ probability of falling into poverty by 7.5%.

  1. *** Denotes statistically significant results 1NR Not reported by the studies. 2 NS Non-significant results
  2. 3OPD: Out-patient care 4 IPD: Inpatient care
  3. 5SE: Subsistence expenditures defined as non- food expenditures (typically set at 40% threshold for health expenditures exceeding this amount i.e. OOPE exceeding 40% of non-food expenditure is considered catastrophic)