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Free Content Costs, equity, efficiency and feasibility of identifying the poor in Ghana’s National Health Insurance Scheme: empirical analysis of various strategies

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Objectives  To analyse the costs and evaluate the equity, efficiency and feasibility of four strategies to identify poor households for premium exemptions in Ghana’s National Health Insurance Scheme (NHIS): means testing (MT), proxy means testing (PMT), participatory wealth ranking (PWR) and geographic targeting (GT) in urban, rural and semi‐urban settings in Ghana.

Methods  We conducted the study in 145–147 households per setting with MT as our gold standard strategy. We estimated total costs that included costs of household surveys and cost of premiums paid to the poor, efficiency (cost per poor person identified), equity (number of true poor excluded) and the administrative feasibility of implementation.

Results  The cost of exempting one poor individual ranged from US$15.87 to US$95.44; exclusion of the poor ranged between 0% and 73%. MT was most efficient and equitable in rural and urban settings with low‐poverty incidence; GT was efficient and equitable in the semi‐urban setting with high‐poverty incidence. PMT and PWR were less equitable and inefficient although feasible in some settings.

Conclusion  We recommend MT as optimal strategy in low‐poverty urban and rural settings and GT as optimal strategy in high‐poverty semi‐urban setting. The study is relevant to other social and developmental programmes that require identification and exemptions of the poor in low‐income countries.

Language: English

Document Type: Research Article


Affiliations: 1:  Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands 2:  Greater Accra Regional Health Directorate, Ghana Health Service, Accra, Ghana

Publication date: January 1, 2012

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