NYMC Student Theses and Dissertations

Date of Award

5-18-2026

Document Type

Doctoral Dissertation - Restricted (NYMC/Touro only) Access

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Kenneth A. Knapp

Second Advisor

Nkem Chukwueme

Third Advisor

Francis Mensah Asenso-Boadi

Abstract

Ghana has operated a social health insurance scheme known as the National Health Insurance Scheme (NHIS) since 2003. The scheme has been the primary tool for Ghana to achieve Universal Health Coverage (UHC) by 2030. The NHIS has been viewed as a model for other African countries due to its progress in reaching a large population in a short period since its implementation. However, despite these successes, Ghana is still several steps behind in achieving UHC, as confirmed by various studies, including findings from the 2014 Ghana Demographic and Health Survey (GDHS). While mass media platforms, such as radio, newspapers, television, and the internet, have the potential to increase awareness and encourage enrollment, their actual impact on NHIS uptake has not been adequately explored by previous studies. Also, the impact of other sociodemographic or geographical factors, like educational levels, household wealth, and place of residence, on the relationship between mass media platforms and NHIS enrollment levels remains largely unexplored. The study aims to determine whether increased educational opportunities, increased household wealth levels, and greater access to media (newspapers, radio, television, or the internet) will increase Ghana's health insurance enrollment, using a highly comprehensive, up-to-date, and nationally representative dataset (2022 Ghana Demographic and Health Survey (GDHS)). This study relies on two complementary theoretical frameworks, Andersen’s Behavioral Model of Health Services Use and the Social Determinants of Health (SDH) Framework, to clarify the factors influencing individual and household decisions about enrolling in health insurance, particularly related to the NHIS. This is a quantitative, cross-sectional study that includes 22,058 participants, comprising 15014 women aged 15-45 years and 7044 men aged 15-52 years from the 2022 wave of the GDHS dataset. The outcome variable was health insurance status. The explanatory variables included demographic and socioeconomic factors such as sex, the highest educational level, wealth index combined, and frequencies of reading newspapers, listening to the radio, watching television, or using the internet. A survey-weighted chi-square test was used for bivariate analysis, and survey-weighted logistic regression models were employed to assess the effect of selected explanatory variables on health insurance enrollment levels, while controlling for each explanatory variable. In the 2022 GDHS dataset, the NHIS enrollment rate is 84%, with a higher rate among women (89.8%) than among men (72.5%). Female and male participants with higher education had 1.31 times and 1.94 times higher likelihood for NHIS enrollment, respectively, compared with those with no education. Compared with poorer households, female and male participants in richer households had 1.48 times and 1.38 times higher likelihood for NHIS enrollment, respectively. Male participants who read newspapers or magazines at least once a day had 1.70 times higher likelihood for NHIS enrollment than those who did not read at all. Male participants who used the internet almost every day had 1.39 times higher likelihood for NHIS enrollment than those who did not use the internet at all. Female participants who listened to the radio at least once a week had 1.25 times higher likelihood for NHIS enrollment than those who did not listen to the radio at all. Female and male participants who watched television at least once a week had 1.25 times and 1.30 times higher likelihood for NHIS enrollment, respectively, than those who did not watch television at all. These findings emphasize the importance of increasing education and household wealth to improve NHIS enrollment in Ghana. Furthermore, using various forms of media access to help improve NHIS enrollment in Ghana has to be gendered.

Keywords

Universal Health Coverage, National Health Insurance Scheme, Demographic and Health Survey, Education, Household Wealth, Media Access, Ghana

Disciplines

Medicine and Health Sciences

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