University of Ghana http://ugspace.ug.edu.gh MULTIVARIATE ANALYSIS TO ASSESS THE EFFECTIVENESS OF THE NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN GHANA BY FRANK OKWAN (10513128) THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE MPHIL DEGREE IN STATISTICS SEPTEMBER, 2015 University of Ghana http://ugspace.ug.edu.gh DECLARATION Candidate’s Declaration This is to certify that this thesis is the result of my own research work and that to the best of my knowledge, no part of it has been presented for the award of any other degree in the university or elsewhere, except where due acknowledgement has been made in the text. SIGNATURE:……………………………… DATE:………………………………….. FRANK OKWAN (10513128) Supervisors Declaration We hereby certify that this thesis was prepared from the candidate’s own work and supervised in accordance with guidelines on supervision of thesis laid down by the University of Ghana. SIGNATURE:……………………. DATE:………………………………. PROF. O.A.Y JACKSON (Supervisor) SIGNATURE:……………………… DATE:…………………………….. PROF. J.B. OFOSU (Co-Supervisor) ii University of Ghana http://ugspace.ug.edu.gh ABSTRACT This thesis provides an assessment of the effectiveness of the National Health Insurance Scheme (NHIS) in Ghana implemented by Act 650 and L.I 1809, 2004. This assessment is done by taking the Akuapem South Mutual Health Insurance Scheme, selected health facilities in the Nsawam- Adoagyiri Municipality and Akuapem South District that provides health insurance services and health insurance users as case study. The selected health facilities are the Nsawam Government Hospital, Pokrom Health Centre, Kom Presby Clinic and New Life Hospital. The purpose of this study was to try to use statistical tools such as regression and hypothesis to determine whether the scheme is effective by using both primary and secondary data. The study employed quantitative and qualitative approach which used secondary and primary data. The study also used descriptive and inferential statistics to analyse the data. The analysis done on secondary data on enrolment recorded from 2010 to 2013 on monthly revealed that enrolment has increased over the period. This is to verify whether there has been an increase in enrolment onto the scheme since its implementation in the study area. Data collected on a number of claims paid to service providers by the scheme also showed that health insurance usage has also increased from 2007 to 2013 on monthly basis. The finding of the study has revealed that 72.9% of respondents who participated in the study to assess the effectiveness of the Nation Health Insurance Scheme responded that the health insurance scheme implemented by Act 650 and L.I 1809, 2004, is effective and can be made more effective if claims payments to service providers are not delayed. iii University of Ghana http://ugspace.ug.edu.gh DEDICATION I dedicate this thesis to the Almighty God for his faithfulness, mercies and endless favour He bestowed on me throughout the trials and tribulation years of my days on campus. I also, dedicate to my dear wife, Abigail Boateng Okwan and my lovely children Isabella Yaa Ehuramah Okwan and Nana Yaw Boateng Okwan. iv University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT All praise and honour to God for the great thing He has done. The giver of all good and perfect gifts, really deserve praise adoration and thanksgiving for his protection and guidance and for granting me wisdom, knowledge and understanding for all these years of my studies and more especially for the great things He is about to do in my life. I will like to express my deepest gratitude to my supervisors: Professor O.A. Y Jackson (Supervisor) and Professor J. B. Ofosu (Co-Supervisor) for their expert advice, encouragement, support, guidance, stimulating criticism, time and energy in putting this work together. To my family, I say thank you for your encouragement, support and advice even when all hopes were lost you kept me going and special thanks to my dear wife Abigail, my two kids and my mother- in-law for their time and understanding throughout these years of study. My sincere appreciation goes to the management of Akuapem South Mutual Health Insurance Scheme, Nsawam, Nsawam Government Hospital, New Life Hospital, Adoagyiri, Pokrom Health Centre and Kom Presby Clinic, Aburi, Dr. Ezekiel Nii Noi Nortey and Gabby Dagadu of the Statistics Department, University of Ghana, Legon for their great contribution and support towards the completion of this work. I would like to acknowledge Mr. Eric Oduro Amparbeng and Mr. Michael Shika Kposu for editing this work. Finally, my greatest thanks goes to all lecturers of the Department of Mathematics and Statistics and my MPhil colleagues who encouraged me anytime I was troubled and also supported me in many ways. I say thank you all and God richly bless you. v University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS Content Declaration……………………………………………………………………….. i Abstract…………………………………………………………………………… ii Dedication………………………………………………………………………… iii Acknowledgement………………………………………………………………… iv Table of Contents………………………………………………………………….. v List of Tables……………………………………………………………………… viii List of Figures……………………………………………………………………... x List of Abbreviations................................................................................................ xi Chapter One.............................................................................................................. 1 Background of the Study.......................................................................................... 1 1.0 Introduction........................................................................................................ 1 1.1 Functions of the NHIS........................................................................................ 3 1.2 Premiums............................................................................................................ 4 1.3 Types of Health Insurance.................................................................................. 6 1.4 Benefits of Health Insurance........................................................................ 8 1.5 Statement of the Problem.................................................................................. 9 vi University of Ghana http://ugspace.ug.edu.gh 1.6 Objectives of the Study……………................................................................. 10 1.7 Research Hypothesis ….................................................................................... 10 1.8 Scope and Geographical Background of the study Area.................................... 10 1.9 Significance of the Study.................................................................................... 13 1.10 Organisation of the Study................................................................................. 13 1.11 Limitations of the study.................................................................................... 13 Chapter Two............................................................................................................. 15 Literature Review..................................................................................................... 15 2.0 Concept of National Health Insurance Scheme (NHIS)..................................... 15 2.1 Global Perspective of Social Health Insurance.................................................. 16 2.2The Development of Health Insurance Scheme in Ghana................................... 19 2.3 The Challenges of NHIS in Developing Countries............................................ 21 2.4 The Structure of National Health Insurance Scheme in Ghana.......................... 23 2.5 The Role of Health Insurance in Health Care Delivery...................................... 26 2.6 Financing of Health Insurance in Ghana............................................................ 28 Chapter Three........................................................................................................... 30 Methodology............................................................................................................. 30 3.0 Introduction....................................................................................................... 30 vii University of Ghana http://ugspace.ug.edu.gh 3.1 Population........................................................................................................... 30 3.2 Sample Size Determination.............................................................................. 30 3.3 Sources of Data................................................................................................... 31 3.4 Sampling Procedure............................................................................................ 32 3.5 Research Design................................................................................................. 32 3.6 Data Collection Methods.................................................................................... 33 3.7 Data Analysis and Presentation.......................................................................... 34 3.8 Kolmogorov-Smirnov Goodness-of-Fit Test………………………………..... 35 3.9 Regression Analysis........................................................................................... 36 3.10 Multiple Linear Regression.............................................................................. 37 Chapter Four………………………………………………………………………. 40 Data Presentation,