Rural – Urban Differences in the Determinants of Enrolment in Health Insurance in Ghana

After seven years of implementation, the National Health Insurance Scheme (NHIS) has achieved varying levels of enrolment coverage within the 10 regions of Ghana with different rural-urban populations. Recent research has identified the determinants of enrolment in the NHIS to include income, age, marital status, employment status, self rated health status and perceived quality of health care services. Implementation problems such as delays in the production and distribution of NHIS ID cards, long waiting times, poor staff attitude, inadequate information on NHIS benefit package and delays in reimbursing health providers has significant deepened the fiscal and coverage challenges of the NHIS and threatens the long term sustainability of the scheme.
Using a sample of 7,084 individuals from the COHEiSION Project baseline survey and employing logistic regression, separate estimations are performed on the rural-urban samples to determine whether there are rural-urban differences in the determinants of demand for health insurance in Ghana. Due to differences in economic and social opportunities, we expect differences in insurance covariates among rural and urban dwellers which will aid in the formulation of policy interventions to address low enrolment in rural and urban populations.