The Role of Universal Health Coverage in Secondary Prevention: A Case Study of Ghana’s National Health Insurance and Early-Onset Hypertension

Owusu Achiaw, S., Geue, C. and Grieve, E. (2023) The Role of Universal Health Coverage in Secondary Prevention: A Case Study of Ghana’s National Health Insurance and Early-Onset Hypertension. Diversity in Health Economics, 15th International Health Economics Association World Congress, Cape Town, South Africa, 08-12 Jul 2023.

Abstract

Background: Launched in 2003, Ghana’s National Health Insurance Scheme (NHIS) was a move towards Universal Health Coverage, equitable healthcare access and outcomes. Only few studies have since investigated the effect of the scheme on health outcomes with a dearth of studies focusing on non-communicable diseases (NCDs) like hypertension. While a major cause of mortality and morbidity, most NCDs, particularly in the early stages, remain undiagnosed in Ghana. Secondary prevention comprising early detection and prompt treatment of NCDs is important in preventing severe complications and consequently reducing mortality and morbidity. In Ghana, however, patients with early signs of NCDs may often avoid seeking health care due to financial barriers. This study aimed to assess the effect of NHIS enrolment on the likelihood of having early-onset hypertension detected and further effects on treatment after diagnosis. Methods: A cross-sectional analysis of the 2014 Ghana Demographic and Health Survey (male dataset) was conducted. The unadjusted analysis involved binary logistic regression with NHIS enrolment as the independent variable and detection of early-onset hypertension as the dependent variable. Early-onset hypertension was defined as the onset of hypertension at 55 years or younger and was diagnosed based on multiple blood pressure measurements taken during the survey. Covariates used for the adjusted regression models were age, BMI, smoking status, place of residence, wealth and education level. The association between enrolment and treatment status, as well as blood pressure control among those who had been diagnosed, was also assessed. Results: Unadjusted and adjusted results showed that the odds of early-onset hypertension being detected in those enroled in the NHIS were respectively 2.1 times (95% CI: 1.38-3.32, p=0.001) and 1.9 times (95% CI 1.25-3.00, p=0.003) that of their unenroled counterparts. The adjusted results showed that of all covariates, educational level, particularly tertiary education was a significant predictor for the detection of early-onset hypertension. There was however no significant association between NHIS enrolment and treatment status and blood pressure control once early-onset hypertension had been diagnosed. Conclusion: This study suggests that NHIS enrolment may play a beneficial role in the secondary prevention of NCDs and may be worth considering as a possible secondary prevention strategy in the country. Further research is nevertheless needed to understand how enrolment, NCDs, and other contextual factors are interrelated to enable efficient employment of the scheme in secondary prevention.

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Grieve, Dr Eleanor and Geue, Dr Claudia and Owusu Achiaw, Dr Samuel
• Authors: Owusu Achiaw, S., Geue, C., and Grieve, E.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment

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