2012年-世界发展银行全球_Health_Equity_and_Financial_Protection_in_Ghana_41页_1mb

Summary of the Health Equity and Financial Protection Report - Ghana

Core Content

This report provides an in-depth analysis of health equity and financial protection in Ghana, focusing on the distribution of health outcomes, care utilization, government spending, and the impact of out-of-pocket (OOP) payments on household financial well-being. The findings are based on data from the 2003 World Health Survey (WHS), 2006 Multiple Indicator Cluster Survey (MICS), 2008 Demographic and Health Survey (DHS), and the 2005/06 Ghana Living Standards Survey (GLSS V). The report uses the ADePT software for all analyses and highlights the role of health financing mechanisms in shaping access and equity in health care.

Main Findings

1. Health Inequalities

• Ill health is more concentrated among the poor in Ghana.
  • Child health indicators such as under-five mortality rate, stunting, underweight, diarrhea, and fever are worse among the poor.
  • Malaria is more prevalent among the better-off, likely due to under-diagnosis among the poor.
  • Adult health indicators show mixed results: some conditions like tuberculosis, non-road traffic accidents, and poor self-assessed health are more common among the poor, while road traffic accidents and obesity (among non-pregnant women) are more concentrated among the wealthy.
  • Risky health behaviors are also unevenly distributed:
    • The poor are more likely to smoke, while the wealthy are more likely to have insufficient intake of fruits and vegetables.
    • The wealthy are more likely to have concurrent sexual partnerships, but also more likely to use condoms during these partnerships.
    • Mosquito net use for children and pregnant women is more concentrated among the poor.

2. Health Care Utilization

• Health care utilization is more concentrated among the better-off.
  • Maternal and child health (MCH) interventions (e.g., immunization, treatment of diarrhea, ARI, antenatal care, skilled birth attendance, and contraceptive prevalence) are more accessible to the wealthy.
  • Adult preventive care (e.g., breast cancer screening) is also more concentrated among the better-off.
  • General health services (outpatient and inpatient) are more utilized by the wealthy.

3. Government Health Spending

• Government health spending is pro-rich.
  • Outpatient care is pro-rich under all assumptions.
  • Inpatient care is pro-rich under two of three methodological assumptions.
  • Total subsidies for health are pro-rich, except for utilization of health centers and posts, which account for only 16.6% of government spending.
  • The GLSS data used in this report pre-date the recent health insurance reform, so the impact of the reform on progressivity is not known.

4. Financial Protection and Out-of-Pocket Payments

• Out-of-pocket payments have a substantial negative impact on household financial well-being.
  • 23.6% of households spent more than 10% of total consumption on health OOP payments.
  • 8.8% of households spent more than 25% of their consumption on health OOP payments.
  • Using a non-food consumption measure, 50.3% of households spent more than 10% of their non-food expenditure on health OOP payments.
  • 22.8% of households spent more than 40% of their non-food expenditure on health OOP payments.
  • Health spending is responsible for impoverishing effects, increasing the poverty rate by 5.5% (US$2.00 a day) and 7.6% (US$1.25 a day), and increasing the depth of poverty by 8.6% at the higher poverty line.

5. Progressivity of Health Financing

• Health financing in Ghana is mostly proportional to income.
  • Taxes are slightly progressive.
  • Social health insurance contributions are mildly progressive.
  • Voluntary health insurance premiums and OOP payments are not statistically significant in terms of progressivity.
  • The recent health insurance reform (NHIS) has not been fully evaluated for its impact on progressivity due to the use of pre-reform data.

Key Information

• Health financing mix (2005–2009):

  • Government spending accounted for 53.2% of total health expenditures.
  • Out-of-pocket payments accounted for 36.8% of total health expenditures.
  • Donor funding played a significant role, contributing to direct budget support, pooled funds, and project-based support.
  • NHIS now accounts for two-thirds of internally generated funds at government facilities and over 40% of total health expenditures.

• Health care delivery system:

  • Managed by the Ministry of Health (MoH) and Ghana Health Services (GHS).
  • Non-governmental organizations (NGOs) are also active in the sector.
  • There are four levels of care in urban areas and five levels in rural areas, with health posts and outreach sites being the first level in rural areas.
  • Physician density is low, with 61% of physicians who graduated between 1985 and 1994 emigrating to other countries.
  • Uneven distribution of health workers disproportionately affects the rural poor, who lack access to urban health facilities.

• Health equity and financial protection goals:

  • The Ghanaian government has prioritized equity in health access and delivery as part of its economic development strategy.
  • The NHIS aims to reduce financial barriers and promote financial protection, but faces challenges such as fraud, weak administration, and sustainability issues due to reliance on tax funding.

Conclusion

The report concludes that health outcomes and care utilization are generally more concentrated among the wealthy, indicating inequities in access to health services. Out-of-pocket payments significantly burden households, particularly the poor, and government spending is pro-rich, suggesting that the current health financing system does not effectively promote financial protection or equity. While the NHIS has improved access and reduced financial barriers, its progressivity remains uncertain due to the pre-reform data used in the analysis. The overall health financing system is mostly proportional to income, with limited progressivity in key areas.