A Subsidized National Health Insurance Scheme: The Experience of Ghana

T. Paul Schultz, Yale University

In five years Ghana has implemented an ambitious National Health Insurance Scheme (NHIS), and registered half of its population in the program. But the composition of those registered and covered by the publicly subsidized program is concentrated among better educated Ghanaians, who are presumably more able to pay the public cost of the scheme and to assess what their future program benefits are worth. This paper analyzes the NHIS enrollment in a nationally representative household survey collected in 2009-10. The household’s proximity to NHIS district administrative offices, program registration fees and renewal premiums, and various exemptions from these fees for subgroups in the population are shown to help explain who joined and stayed in the program, and quantifies how changes in policies could expand coverage further, especially among the least educated and most remotely located segments of the population, and thereby increase equitably the program’s coverage.