Health Insurance in Ghana and Tanzania: Addressing Equity and Accessibility

Start date
January 1, 2009
End date
July 1, 2014
Project code
Total grant
Contact person
Ulrika Enemark

The aim of the project is to study the contribution of health insurance schemes to achieving health sector objectives such as access, equity, efficiency, resource mobilisation, risk protection and improvements in health in Tanzania and Ghana. The specific focus will be on: (a) the association between characteristics of health insurance schemes (in terms of design and practical implementation) and performance on health sector objectives, (b) equity in access and utilisation in populations in which some are insured - what are the implications for the poor?; (c) the association between health insurance and health; (d) the quality of health services for insured and non-insured, and; (e) risk equalisation between insurance schemes as a means to increase accesss to health services. An additional objective is to develop and finalise 4 PhD projects as well as strengthen the research collaboration and exchange of experience within the area of health care financing in Ghana, Tanzania and Denmark. The project consists of five sub-projects, one of which is a collaborative project between researchers in Tanzania and Denmark and four PhD projects (two each from Ghana and Tanzania). The projects overlap and complement each other and will to a large extent make use of joint data collection and data sets. A household survey is planned in both countries and additionally as survey among health insurance schemes is planned in Tanzania. The results of the research will be disseminated in scientic articles as well as in more popular forum to stakeholders in the two countries, including Danida, with a view to presenting and discussing concrete recommendations for policy development as well as practical implementation.


Completion Report - Summary:

Based on household surveys, patient exit surveys and in-depth interviews in Ghana and Tanzania, the project contributed to the evidence on the impact of health insurance. As expected, health insurance provides financial protection, increases utilisation of formal health care, in particular hospital services, and likeiihood of membership increases with increaslng wealth. However, membership does not have a larger effect on treatment seeking behavior of the least wealthy as compared to the wealthiest. Membership contributions was not found unaffordable in absolute sense, but appeared to be part of a value for money assessment against the expected capacity of the system to deliver timely quality healthcare. Quallty of care received did not differ much by insurance status, but adherence to standard guidelines was generally low. We found no significant effect on self-assessed health status, but number of workdays lost to illness was lower among insured, and the insured were more likely to engage in healthy behavior. In Tanzania, the higher proportion of CHF than NHIF households reporting identified risk factors for healthcare utilisation and less wealth suggests a need for risk equalization to increase equity. The majority supported redistribution across the funds and favored a partial subsidy. The project resulted in 4 PhDs, in a data set available for further analysls, and In strengthened collaboration in health economics research between Ghana, Tanzania and Denmark.