Vertical Equity in Access to Health Insurance Services: a Qualitative Analysis of Perceptions and Enrollment in the Jirapa Municipality, North-Western Ghana. Maximillian Kolbe Domapielle (
[email protected] ) University for Development Studies https://orcid.org/0000-0002-0807-0420 Constance Awinpoka Akurugu University for Development Studies Emmanuel Kanchebe Derbile University for Development Studies Research Keywords: Health insurance, vertical equity, premium, access to health care, northern Ghana. Posted Date: August 6th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-53247/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/24 Abstract Background: Given concerns about the spiralling cost of health services in Low and Middle Income Countries (LMICs), this study draws on a framework for assessing poverty and access to health services to ascertain progress towards achieving vertical equity in the National Health Insurance Scheme (NHIS) in a rural setting in northern Ghana. Rural-urban disparities in nancial access to NHIS services are seldom explored in equity-related studies although there is a knowledge gap of progress and challenges of implementing the scheme’s vertical equity objectives to inform social health protection planning and implementation. Methods: A qualitative approach was used to collect and analyse the data. Specically, in-depth interviews and observation provided the needed data to critically analyse the relationship between location, livelihoods and ability to pay for health insurance services. Results: The article found that at rate contributions for populations in the informal sector of the economy and lack of exibility and adaptability of timing premium collections to the needs of rural residents make the cost of membership disproportionately higher for them, and this situation contradicts the vertical equity objectives of the NHIS.