A Systematic review of macro - and meso - determinants of national health insurance enrolment among older adults in Ghana

Abstract

: Achieving universal health coverage (UHC) through the National Health Insurance Scheme (NHIS) has been a priority for Ghanaian governments. Despite the plethora of studies conducted to explore the various factors that influence enrolment into the scheme, there remains a dearth in the literature with regards to a systematic review of the health- and system-level determinants of NHIS enrolment among older adults in Ghana. This study aimed to synthesize evidence on macro- and meso-level determinants of NHIS enrolment among older adults in Ghana. With literature from data repositories including Wiley Web of Science, PubMed, PsycINFO, Scopus, Ovid, Science Direct and Sage, we performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Out of 124 studies screened, the systematic review included 11 articles. The study identified 4 macro- and 3 meso-determinants of national health insurance enrolment among older adults in Ghana. Macro-determinants identified were perceived scheme benefits, affordability, proximity to NHIS offices, quality of administrative service delivery. Physical accessibility, quality of care, and staff attitude were identified as meso-determinants. The study recommends improving physical accessibility, quality of care, and staff attitude. Additionally, it suggests addressing perceived scheme benefits and improving the quality of administrative service delivery.