American Journal of Public Health Research, 2014, Vol. 2, No. 1, 27-35 Available online at http://pubs.sciepub.com/ajphr/2/1/6 © Science and Education Publishing DOI:10.12691/ajphr-2-1-6 Demand for Health Insurance in Ghana: What Factors Influence Enrollment? Ebenezer Owusu-Sekyere 1,* , Anthony Chiaraah 2 1 Department of Development Studies, University for Development Studies, WA, Ghana 2 Department of Economics and Entrepreneurship Development, University for Development Studies, WA, Ghana *Corresponding author: oseturbo@yahoo.com Received November 16, 2013; Revised January 17, 2014; Accepted February 09, 2014 Abstract In 2003, there was a paradigm shift in Ghana’s quest for a more humane, affordable and reliable mechanism of financing healthcare with the introduction of the national health insurance scheme. The scheme was to replace the hitherto obnoxious Cash and Carry System of paying for health care at the point of service, and to provide a better and much more humane financial arrangement that will enable the citizens to access health care service without having to pay at the point of service delivery and also ensure an improvement in the quality of basic health. This study employed descriptive statistics-Logit and Probit Models to investigate the factors that influence Ghanaians to enroll with the scheme. The results from the logit and probit models indicate that sex, marital status and cost of curative care were strong factors in influencing one’s decision to join the scheme. Again the marginal effects and odd ratios gave a further indication that factors such as individuals’ income, higher levels of education and poor ill health among others also influence Ghanaians to join the scheme. This research is of the view that any public education aimed at increasing enrollment should be guided by these factors. Keywords: National Health Insurance, healthcare financing, cash and carry, logit and probit, enrollmen Cite This Article: Ebenezer Owusu-Sekyere, and Anthony Chiaraah, “Demand for Health Insurance in Ghana: What Factors Influence Enrollment?” American Journal of Public Health Research, vol. 2, no. 1 (2014): 27-35. doi: 10.12691/ajphr-2-1-6. 1. Introduction One major challenge facing health delivery in Ghana is financing. Health financing in Ghana Prior to independence, was predominantly by out-of-pocket payments at point of service use [1]. This however changed under the First Republic, from the late 1950s up to 1966, when healthcare financing in Ghana was in line with the Socialist philosophy of the then Government, and was virtually free as was education and other social services. Following the overthrow of the government, Healthcare financing in Ghana saw a complete ‘U-Turn’ [2]. Under the military-cum-civilian junta of the National Liberation Council (NLC), Ghanaians were asked to pay for their healthcare. This continued till the introduction of the National Health Insurance Scheme NHIS in 2004 [3]. As at 1981, the economy of Ghana had deteriorated to such an extent that the government wandered how to find the best combination of Government-Peoples-Partnership that would meet each other part of the way and satisfy the needs and pockets of Ghanaians as well the Government’s finances in the healthcare sector [4]. ‘Cash and Carry’ system of healthcare financing was thus introduced. Under Cash and Carry’, patients were required to pay for drugs and some medical consumables, as and when they visit hospital, while the state bore all other costs including consultation, salaries and emoluments for Doctors, Nurses and other healthcare workers in state hospitals. ‘Cash and Carry’ also provided for free medical care for the aged above 70 years of age, children under five years and pregnant women for their ante-natal care, all under an exemption programme implemented with that system of financing. The ‘Cash and Carry’ system survived until 2004 when the present health insurance system came into being [5]. The National Health Insurance Scheme (NHIS) was established under Act 650 of 2003 by the Government of Ghana to provide basic healthcare services to persons resident in the country through mutual and private health insurance schemes. Act 650 of 2003 has been amended and replaced with National Health Insurance act 852 of, 2012 to cater for the inconsistencies and the legal ambiguities in the previous act. The purpose of the amendment was also to cater for the changing developmental trends in the health sector and to solidify the gains made ten years after the implementation of the scheme. The new act recognizes the existence the District Mutual, Private Mutual and Private Commercial Schemes which are regulated by the National Health Insurance Council (NHIC). Ghana introduced a national health insurance scheme (NHIS) as part of a major development policy framework-Ghana Poverty Reduction Strategy (GPRS) implemented in 2003. The aim of the NHIS was to replace the hitherto obnoxious Cash and Carry System of paying for health care at the point of service, and to provide a better and much more humane financial