Could cost sharing sustain the Ghana National Health Insurance Scheme?

This paper estimates the effect of cost sharing on the sustainability of the Ghana National Health Insurance Scheme (NHIS) from the point of view of enrollment, utilization, and financing. We use data from a nationwide survey to estimate the retention of subscribers and propensity to utilize the scheme's benefit package under a cost sharing policy. The estimates from the survey are used together with data on the Ghana NHIS, to estimate the patronage, and financial status of the Ghana NHIS had cost sharing been introduced. The result indicates that a 5% cost sharing rate would have kept the scheme in surplus between 2007 and 2015. In addition, the 5% cost sharing rate would have led to virtually no change in enrollment and would have reduced utilization rate by about 15%. It is also found that women have higher enrollment and utilization of health insurance than men under cost sharing.