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Background <p>Clients insured by Ghana’s National Health Insurance Scheme (NHIS) who seek healthcare at credentialed facilities incur substantial out-of-pocket (OOP) payments for services covered by the scheme. While co-payments are part of OOP payments, the extent of these co-payments has received limited empirical attention. This study sought to determine co-payment levels and identify the social and demographic factors associated with co-payment for outpatient services, inpatient care, and drugs among insured clients of the scheme.</p> Methods <p>We used the 2022 Ghana Demographic and Health Survey data. This was a cross-sectional design, which employed a stratified two-stage random sampling technique. We analysed data involving 8,467 respondents with information on utilisation and payment for health services. Data were analysed using Stata version 16. Descriptive and inferential statistics were performed with statistical significance at <i>p</i> &lt; 0.05.</p> Results <p>Among insured clients who made any out-of-pocket payment, 58.4% reported it as a co-payment for drugs, 52.5% for inpatient care, and 48.4% for outpatient consultation. Respondents aged 25–34 years (AOR: 0.43; CI: 0.18–0.99; <i>p</i> &lt; 0.05) had significantly reduced odds of co-payment for inpatient care, while urban residents had increased odds of co-payment for drugs (AOR: 1.42; CI: 1.03–1.95; <i>p</i> &lt; 0.05) compared to their rural counterparts. Furthermore, being from the Eastern (<i>p</i> &lt; 0.05), Upper West (<i>p</i> &lt; 0.05) and Northern (<i>p</i> &lt; 0.05) regions was associated with reduced odds of co-payment for outpatient consultation and drugs. However, compared to no formal education, having primary education statistically significantly increases the odds of co-payment for outpatient consultation (AOR: 2.66; CI: 1.13–6.27; <i>p</i> &lt; 0.05) and drugs (AOR: 1.82; CI: 1.11–2.99; <i>p</i> &lt; 0.05) while being rich significantly reduces the odds of co-payment for outpatient consultation (AOR: 0.40; CI: 0.19–0.84; <i>p</i> &lt; 0.05).</p> Conclusion <p>Insured clients presenting at credentialed health facilities make co-payments for outpatient services, inpatient care, and drugs covered by the scheme. The study highlights the multifaceted determinants of co-payments. The extent of co-payments may impede Ghana’s progress toward achieving Universal Health Coverage (UHC). There is a need to eliminate co-payments for outpatient services, inpatient care, and drugs for insured clients to realize the UHC goal.</p>

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Co-payments for healthcare by insured clients of Ghana’s National Health Insurance Scheme: evidence from the 2022 Ghana Demographic and Health Survey

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  • 发表日期：

    2026年6月23日

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  • Roger Ayimbillah Atinga,
  • Dominic Dormenyo Gadeka,
  • Ambrose Azenyinkajigi Adama

摘要

Background

Clients insured by Ghana’s National Health Insurance Scheme (NHIS) who seek healthcare at credentialed facilities incur substantial out-of-pocket (OOP) payments for services covered by the scheme. While co-payments are part of OOP payments, the extent of these co-payments has received limited empirical attention. This study sought to determine co-payment levels and identify the social and demographic factors associated with co-payment for outpatient services, inpatient care, and drugs among insured clients of the scheme.

Methods

We used the 2022 Ghana Demographic and Health Survey data. This was a cross-sectional design, which employed a stratified two-stage random sampling technique. We analysed data involving 8,467 respondents with information on utilisation and payment for health services. Data were analysed using Stata version 16. Descriptive and inferential statistics were performed with statistical significance at p < 0.05.

Results

Among insured clients who made any out-of-pocket payment, 58.4% reported it as a co-payment for drugs, 52.5% for inpatient care, and 48.4% for outpatient consultation. Respondents aged 25–34 years (AOR: 0.43; CI: 0.18–0.99; p < 0.05) had significantly reduced odds of co-payment for inpatient care, while urban residents had increased odds of co-payment for drugs (AOR: 1.42; CI: 1.03–1.95; p < 0.05) compared to their rural counterparts. Furthermore, being from the Eastern (p < 0.05), Upper West (p < 0.05) and Northern (p < 0.05) regions was associated with reduced odds of co-payment for outpatient consultation and drugs. However, compared to no formal education, having primary education statistically significantly increases the odds of co-payment for outpatient consultation (AOR: 2.66; CI: 1.13–6.27; p < 0.05) and drugs (AOR: 1.82; CI: 1.11–2.99; p < 0.05) while being rich significantly reduces the odds of co-payment for outpatient consultation (AOR: 0.40; CI: 0.19–0.84; p < 0.05).

Conclusion

Insured clients presenting at credentialed health facilities make co-payments for outpatient services, inpatient care, and drugs covered by the scheme. The study highlights the multifaceted determinants of co-payments. The extent of co-payments may impede Ghana’s progress toward achieving Universal Health Coverage (UHC). There is a need to eliminate co-payments for outpatient services, inpatient care, and drugs for insured clients to realize the UHC goal.