How does social health insurance influence seeking care in Kenya and Ghana?

Social Health Insurance (SHI), a system involving pooling risks and funds from individuals, government and other entities, is often used by countries to move toward ensuring everyone can receive affordable health services. Previous studies have found SHI to be an encouraging strategy for achieving universal health coverage although some low-income countries can struggle to implement SHI systems due to mistrust in public health systems, low re-enrollment rates, and a lack of sustainable funding. 

Accident & emergency wing of hospital

New research from Bixby member Dr. Lauren Suchman examines how SHI impacts patient decision-making about when and where to seek care in Kenya and Ghana. Despite the presence of SHI in both countries, previous studies have shown that people who are covered under SHI are often reluctant to use it because providers request informal payments or treat them poorly when they try to pay with SHI (as opposed to out of pocket). Widespread delays in reimbursements may result in providers shifting costs to patients by charging them for services that should be covered. Patients sometime report discontinuing their SHI enrollment because they believe it covers very little.

Dr. Suchman’s research found that patients reported seeking care more frequently when covered by a SHI program because it was more affordable, suggesting that SHI programs have the potential to increase access to health care in both Ghana and Kenya. Many patients noted that their SHI coverage gave them access to a wider variety of providers, although they still most commonly selected a healthcare facility because it was nearby. Countries should incentivize providers to work in rural areas and accredit rural facilities to increase accessibility and reach.

Generally, patients trusted the SHI system; however, there were exceptions in Ghana where the program has recently been underfunded and delayed reimbursements to providers sometimes led to more out-of-pocket payment for patients. In both countries, patients were sometimes charged for services that should have been covered by the SHI programs and they rarely knew they had been incorrectly charged. Providers and patients in both countries would benefit from education on how the SHI coverage works, how to use it, and what services are covered. Providers also need to be monitored and held accountable for misusing the system through monitoring mechanisms built into the systems.

Increased education on SHI, stricter provider monitoring, and incentives for rural providers can help ensure a more comprehensive reach by SHI systems, greater enrollment numbers and trust in the system. These recommendations, coupled with continued use of SHI programs, can help bring countries like Kenya and Ghana closer to achieving universal health coverage.