Two decades of Ghana’s National Health Insurance Scheme: perceived service quality and membership renewal among informal sector workers

BACKGROUND: Two decades into Ghana's National Health Insurance Scheme (NHIS), concerns about service quality and drop-out persist. OBJECTIVES: This study aimed to measure multidimensional perceived service quality and its associations with NHIS membership renewal among informal-sector workers in two socio-economically distinct regions in Ghana. METHODS: Building upon the classic frameworks on service quality, a cross-sectional survey was conducted. Descriptive comparison followed by multivariable logistic regressions was performed, adjusting for sociodemographic characteristics selected based on conceptual relevance and the significance of unadjusted estimates. RESULTS: < 0.05) by insurance status, with NHIS dropouts reporting the least favorable experiences across all quality dimensions. The regression estimates showed that respondents who obtained all or some of their prescribed medications or diagnostic tests had higher odds of renewing their membership than those who did not. Reasonable waiting times for consultation (aOR = 5.86, CI: 3.27-10.49) and for diagnostics (aOR = 7.57, CI: 3.61-15.88) were positively associated with renewal. Professional staff disposition (aOR = 3.60, CI: 2.05-6.34) and a better doctor-patient relationship (aOR = 2.79, Cl: 1.90-4.11) were also significantly associated with higher odds of NHIS renewal. CONCLUSIONS: This study underscores the need for effective resource allocation to improve service quality across critical dimensions. Findings can inform health policy in similar settings, reflecting perceived service quality as key to health insurance retention.