Universal health coverage in the context of population ageing: spatial analysis of the enrolment in the National Health Insurance scheme in Ghana

Nele van der Wielen, University of Southampton
Amos R. Channon, University of Southampton
Jane C. Falkingham, University of Southampton

Population ageing advances considerable challenges to universal health coverage (UHC). Ghana presents a crucial case study of geospatial influences on the implementation of policies aimed at UHC in the context of population ageing in low and middle-income countries. Ghana has witnessed profound demographic transitions including large increases in the number of older adults when implementing policies aimed at UHC. Using the Ghanaian Living Standards Survey from 2012-2013 spatial and aspatial determinants of National Health Insurance Scheme (NHIS) enrolment for individuals over the age of 50 are examined through the application of multilevel regression and spatial cluster analysis. While previous studies have mainly focused on demographic and socio-economic factors, analysis of spatial barriers show that NHIS enrolment is a matter of geographical accessibility. Results show that there are great inequalities in enrolment, by wealth and travel time to health care services.