Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme
Objectives The study aimed to understand the impact of integrating a fee waiver for the National Health Insurance Scheme (NHIS) with Ghana’s Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer programme on health insurance enrolment.Setting The study was conducted in five districts impl...
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e028726.full |
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| author | Tia M Palermo Clare Barrington Elsa Valli Gustavo Ángeles-Tagliaferro Marlous de Milliano Clement Adamba Tayllor Renee Spadafora Tia Palermo Richard de Groot Isaac Osei-Akoto Joseph K. Darko Robert Darko Osei Francis Dompae Nana Yaw Gustavo Angeles Sudhanshu Handa Frank Otchere Marlous de Miliano Akalpa J Akaligaung Raymond Aborigo |
| author_facet | Tia M Palermo Clare Barrington Elsa Valli Gustavo Ángeles-Tagliaferro Marlous de Milliano Clement Adamba Tayllor Renee Spadafora Tia Palermo Richard de Groot Isaac Osei-Akoto Joseph K. Darko Robert Darko Osei Francis Dompae Nana Yaw Gustavo Angeles Sudhanshu Handa Frank Otchere Marlous de Miliano Akalpa J Akaligaung Raymond Aborigo |
| author_sort | Tia M Palermo |
| collection | DOAJ |
| description | Objectives The study aimed to understand the impact of integrating a fee waiver for the National Health Insurance Scheme (NHIS) with Ghana’s Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer programme on health insurance enrolment.Setting The study was conducted in five districts implementing Ghana’s LEAP 1000 programme in Northern and Upper East Regions.Participants Women, from LEAP households, who were pregnant or had a child under 1 year and who participated in baseline and 24-month surveys (2497) participated in the study.Intervention LEAP provides bimonthly cash payments combined with a premium waiver for enrolment in NHIS to extremely poor households with orphans and vulnerable children, elderly with no productive capacity and persons with severe disability. LEAP 1000, the focus of the current evaluation, expanded eligibility in 2015 to those households with a pregnant woman or child under the age of 12 months. Over the course of the study, households received 13 payments.Primary and secondary outcome measures Primary outcomes included current and ever enrolment in NHIS. Secondary outcomes include reasons for not enrolling in NHIS. We conducted a mixed-methods impact evaluation using a quasi-experimental design and estimated intent-to-treat impacts on health insurance enrolment among children and adults. Longitudinal qualitative interviews were conducted with an embedded cohort of 20 women and analysed using systematic thematic coding.Results Current enrolment increased among the treatment group from 37.4% to 46.6% (n=5523) and decreased among the comparison group from 37.3% to 33.3% (n=4804), resulting in programme impacts of 14 (95% CI 7.8 to 20.5) to 15 (95% CI 10.6 to 18.5) percentage points for current NHIS enrolment. Common reasons for not enrolling were fees and travel.Conclusion While impacts on NHIS enrolment were significant, gaps remain to maximise the potential of integrated programming. NHIS and LEAP could be better streamlined to ensure poor households fully benefit from both services, in a further step towards integrated social protection.Trial registration number RIDIE-STUDY-ID-55942496d53af. |
| format | Article |
| id | doaj-art-6fe1571119114bb6ae45e79cd843b0ee |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-6fe1571119114bb6ae45e79cd843b0ee2024-11-29T08:40:12ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2018-028726Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance SchemeTia M Palermo0Clare Barrington1Elsa Valli2Gustavo Ángeles-Tagliaferro3Marlous de Milliano4Clement Adamba5Tayllor Renee Spadafora6Tia PalermoRichard de GrootIsaac Osei-AkotoJoseph K. DarkoRobert Darko OseiFrancis DompaeNana YawGustavo AngelesSudhanshu HandaFrank OtchereMarlous de MilianoAkalpa J AkaligaungRaymond Aborigo1 Department of Epidemiology and Environmental Health, University at Buffalo – The State University of New York, Buffalo, New York, USADepartment of Health Behavior, University of North Carolina, Chapel Hill, NC, USA2 Social and Economic Policy Unit, United Nations Children`s Fund, Office of Research Innocenti, Firenze, Italy3 UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA3 UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA5 School of Education and Leadership, University of Ghana, Accra, Ghana6 Social Policy and Evidence Section, United Nations Children`s Fund, Accra, GhanaObjectives The study aimed to understand the impact of integrating a fee waiver for the National Health Insurance Scheme (NHIS) with Ghana’s Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer programme on health insurance enrolment.Setting The study was conducted in five districts implementing Ghana’s LEAP 1000 programme in Northern and Upper East Regions.Participants Women, from LEAP households, who were pregnant or had a child under 1 year and who participated in baseline and 24-month surveys (2497) participated in the study.Intervention LEAP provides bimonthly cash payments combined with a premium waiver for enrolment in NHIS to extremely poor households with orphans and vulnerable children, elderly with no productive capacity and persons with severe disability. LEAP 1000, the focus of the current evaluation, expanded eligibility in 2015 to those households with a pregnant woman or child under the age of 12 months. Over the course of the study, households received 13 payments.Primary and secondary outcome measures Primary outcomes included current and ever enrolment in NHIS. Secondary outcomes include reasons for not enrolling in NHIS. We conducted a mixed-methods impact evaluation using a quasi-experimental design and estimated intent-to-treat impacts on health insurance enrolment among children and adults. Longitudinal qualitative interviews were conducted with an embedded cohort of 20 women and analysed using systematic thematic coding.Results Current enrolment increased among the treatment group from 37.4% to 46.6% (n=5523) and decreased among the comparison group from 37.3% to 33.3% (n=4804), resulting in programme impacts of 14 (95% CI 7.8 to 20.5) to 15 (95% CI 10.6 to 18.5) percentage points for current NHIS enrolment. Common reasons for not enrolling were fees and travel.Conclusion While impacts on NHIS enrolment were significant, gaps remain to maximise the potential of integrated programming. NHIS and LEAP could be better streamlined to ensure poor households fully benefit from both services, in a further step towards integrated social protection.Trial registration number RIDIE-STUDY-ID-55942496d53af.https://bmjopen.bmj.com/content/9/11/e028726.full |
| spellingShingle | Tia M Palermo Clare Barrington Elsa Valli Gustavo Ángeles-Tagliaferro Marlous de Milliano Clement Adamba Tayllor Renee Spadafora Tia Palermo Richard de Groot Isaac Osei-Akoto Joseph K. Darko Robert Darko Osei Francis Dompae Nana Yaw Gustavo Angeles Sudhanshu Handa Frank Otchere Marlous de Miliano Akalpa J Akaligaung Raymond Aborigo Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme BMJ Open |
| title | Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme |
| title_full | Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme |
| title_fullStr | Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme |
| title_full_unstemmed | Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme |
| title_short | Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme |
| title_sort | impact evaluation of a social protection programme paired with fee waivers on enrolment in ghana s national health insurance scheme |
| url | https://bmjopen.bmj.com/content/9/11/e028726.full |
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