Unawareness of Health Insurance Expiration Status among Women of Reproductive-Age in Northern Ghana: Implications for Achieving Universal Health Coverage

Edmund Kanmiki
Ayaga Bawah, Regional Institute for Population Studies
Patrick Asuming, University of Ghana
Koku Awoonor-Williams, Ghana Health Service
James F. Phillips, Heilbrunn Department of Population and Family Health, Columbia University, New York, NY 10032, USA

Ghana implemented a national health insurance scheme to promote the provision of affordable and equitable healthcare. However, over a decade of implementation, active enrollment onto the scheme is still low. We assess factors explaining this problem by examining correlates of insurance status unawareness using a random probability cross-sectional survey of 5,914 reproductive-age women. Respondents were asked if they currently have a valid health insurance card. Those who answered yes were then requested to show their cards, thereby enabling interviewers to determine their validity. 61.1% of respondents who reported to be enrolled could produce their cards and 34.4% of these were expired. Factors predicting unawareness of card expiration were occupation, district and socioeconomic status. Unawareness was observed to increase monotonically with relative poverty. Educational messages aimed at improving health insurance coverage should include the promotion of annual renewal and also focus on information needs of low socioeconomic groups.