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Table 4 Summary of Statistical Analysis and Outcomes Reported by the Included Studies

From: Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review

General Information Outcomes Statistical Analysis
First Author Publication Year Citation/Title Outcomes measured Measures of financial risk protection Reduction in out of pocket expenditure (OOPE) Reduction in catastrophic health expenditure (CHE) Poverty reduction Type of statistical analysis Logistic regression (N) number of variables Key findings
Chankova 2008 Chankova S, Sulzbach S, Diop F. Impact of mutual health organizations: evidence from West Africa. Health Policy and Planning. 2008;23(4):264–276. Direct OOPE(s) for inpatient, outpatient care, & transportation cost NR1 OPD3 NS2 Transportation NS2 IPD OOPE*** (NHIS $4.25USD, uninsured $43.88USD) NR1 NR1 Descriptive statistics, logistic regression (8) Independent variables, dependent variable (OOPE) 1.) Insurance was associated with lower out of pocket payments for inpatient care. 2.) No significance difference in outpatient care. 3.) No difference in transportation cost
Nguyen 2011 Nguyen HT, Rajkotia Y, Wang H. The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts. International Journal for Equity in Health. 2011, 10: 4–https://doi.org/10.1186/1475-9276-10-4. OOPE(s) & CHE(s) for illness, surgery, ANC & inpatient care 4 indicators of CHE(s); (5% & 10% of individual income) and (10% & 20% of SE(s)5 OOPE*** NHIS 21000 GH¢ ($2.3 USD), uninsured 30,000 GH¢ ($ 3.2 USD) NHIS reduced CHE(s) by 0.5 to 1% depending on the threshold used. NR1 Descriptive statistics, logistic regression (6) Independent variables, dependent variable (OOPE) NHIS reduces the probability of incurring CHE(s).
Dalaba 2014 Dalaba M, Akweongo P, Aborigo R, Awine T, Azongo D, Asaana P et al. Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts? Global Health Action. 2014;7(1):23848. Direct OOPE(s) for malaria treatment, lost wages & transportation cost NR1 NS2 NR1 NR1 Descriptive statistics NR1 1.) NHIS has some protective effect on cost of malaria treatment, however not statistically significant 2.) Indirect costs of treating malaria were three times higher than direct costs for both insured and uninsured households.
Abrokwah 2014 Abrokwah SO, Moser CM, Norton EC. The effect of social health insurance on prenatal care: the case of Ghana. Int J Health Care Finance Econ. 2014;14(4):385–406. Prenatal care utilization & OOPE(s) per ANC visit NR1 OOPE*** NHIS 3600GH¢ ($0.40 USD), uninsured 21,000 GH¢ ($2.40 USD) for the first ANC visit NR1 NR1 Descriptive statistics, logistic regression (7) Independent variables, dependent variable (prenatal OOPE) 1.) Insured women spend less on prenatal care compared to the uninsured. 2.) Having insurance increases the number of prenatal care visits by 24% relative to being uninsured.
Abuosi 2015 Abuosi A, Adzei F, Anarfi J, Badasu D, Atobrah D, Yawson A. Investigating parents/caregivers financial burden of care for children with non-communicable diseases in Ghana. BMC Pediatrics. 2015;15(1). Financial burden/ OOPE direct inpatient care & perceived financial difficulties NR1 used an arbitrary threshold of > 50 GH¢. as expensive or burdensome NR1 NR1 NR1 Descriptive, logistic regression (11) Independent variables, dependent variable (financial burden of care) Uninsured respondents were twenty- three times more likely than the insured to make higher out of pocket payments for hospitalizations and more likely to experience financial burden of care.
Kusi 2015 Kusi A, Hansen K, Asante F, Enemark U. Does the National Health Insurance Scheme provide financial protection to households in Ghana? BMC Health Services Research. 2015;15(1). Direct OOPE(s) for inpatient, outpatient care, & transportation cost 10% of total household expenditures & SE(s)5 at (20% & 40% thresholds) OOPE*** OPD3; NHIS 6.7 GH¢ uninsured 25.5GH¢. IPD4*** NHIS 44.25GH¢ uninsured 86.73 GH¢. Transportation cost NS2 6% of NHIS respondents compared to 23.2% of the uninsured made CHE(s) NR1 Descriptive statistics, logistic regression (6) Independent variables, dependent variable (CHE) 1.) NHIS significantly reduces the probability of a household incurring CHE(s). 2.) Households with at least one member having a chronic illness were 94% higher than those without a chronic illness to incur CHE.
Aryeetey 2016 Aryeetey G, Westeneng J, Spaan E, Jehu-Appiah C, Agyepong I, Baltussen R. Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana’s National Health Insurance Scheme. International Journal for Equity in Health. 2016;15(1). Direct OOPE(s) for inpatient, outpatient care, & transportation cost SE(s)5 at (40% threshold) IPD4 NS2 2009 OOPE ***OPD3 NHIS GH¢ 19.8 uninsured GH¢ 27.4. 2011 OOPE*** OPD3 NHIS 26.1GH¢ uninsured 53.2GH¢. Transportation cost NR1 In 2009, 18.4% of NHIS respondents made CHE(s), compared to 36.1% uninsured. In 2011 7.1% NHIS & 28.7% Uninsured NHIS households were 7.5% less likely to fall into poverty. Descriptive statistics, logistic regression (9) Independent variable Insurance status, dependent variable (OOPE) 1.) Enrolment in health insurance reduced household OOPE by 86%. 2.) Insured households were 3% less likely to make CHE(s). 3.) Being insured reduces households’ probability of falling into poverty by 7.5%.
  1. *** Denotes statistically significant results 1NR Not reported by the studies. 2 NS Non-significant results
  2. 3OPD: Out-patient care 4 IPD: Inpatient care
  3. 5SE: Subsistence expenditures defined as non- food expenditures (typically set at 40% threshold for health expenditures exceeding this amount i.e. OOPE exceeding 40% of non-food expenditure is considered catastrophic)