The study sought to elicit from participants reasons for the nonrenewal of NHIS membership cards among healthcare workers in the Kintampo North Municipality (KNM) of the Bono East Region of Ghana. The mean and median average ages of the participants were 3.13 ± 4.7 and 30 years respectively. The age characteristics displayed an active and productive adult population in the study area which has the capabilities of adding on to labour force. This is in line with and the National Population and Housing Census 2021. The age structures depict an active and productive adult population hence could be a reason why majority could afford to subscribe and renew their NHIS membership cards.
Data from the study also indicated a higher and least monthly income earnings of 2000 Ghana Cedis (282.20 USD) and 500 Ghana Cedis (70.55) respectively. This revelation is inconsistent with a similar study carried out among households in the Ashanti Region which reported 412.94 Ghana Cedis (108.12USD) and 200 Ghana Cedis (52.35USD) respectively. Also, further findings from the study on the socio-economic characteristics of the study participants do not agree with [16, 17] outcomes that suggested minimum monthly earnings of 200 Ghana Cedis and 300 Ghana Cedis respectively. These minimum monthly income earnings may be as a result of the kind of services they provide, their corresponding salaries, their market premiums and conditions of service, but, this may not translate into the real standard of living of the health workers in the municipality since the actual standard of living could be influenced by their families, household sizes and the state of the country’s economy.
Majority of the participants had some form of certificates. This is consistent with studies by[14, 18] which revealed that majority(more than 60%) and more than a third had graduated from senior high school or more respectively. Likewise, the finding in this study supports another one by . However, most of the participants in this study were tertiary graduates which do not support previous findings from studies carried out in Dormaa Municipality of Ghana and [4, 5, 7]. Again, our finding on the level of education (tertiary) contradicts that of  in the Hohoe Municipality of Ghana. A similar study carried out in Nigeria discovered higher level of education being first degree . The difference in the level of education could be as result of the kind of services they provide and the certificate requirements for that form of employment.
Almost all the respondents were NHIS subscribers and majority of them had a valid NHIS membership cards. This finding is consistent with that of [4, 21] which reported higher proportions for those in the East Gonja District and patients who visited some selected healthcare delivery centers in some selected areas in Ghana. However, it is inconsistent with a similar study carried out by  which discovered that NHIS subscription and renewal rate were low. Again, our finding does not support the study by  which revealed that SSNIT contributors are unlikely to subscribe and renew their memberships with the NHIA. This could be ascribed to the study participants’ job descriptions, knowledge and experience they have gained on how to prevent diseases and not falling sick. Inferences from the study points that, most of the healthcare providers in KNM use NHIS as the key means of seeking healthcare. However, this current study discovery is about twice more than that of the 2012 and 2013 national level active NHIS membership which stands at 37% and 38% respectively.Similarly, this study outcome is higher than that of a study established by in Barekese in the Ashanti Region of Ghana. It supports a study by  that revealed increment in NHIS subscriptions. Additionally, available literature from indicated that majority(63.0%) had not renewed their NHIS membership cards which is in contradiction to this current study which revealed less than half of the respondents not renewing their NHIS membership cards. Majority of our study participants were however, willing to renew their NHIS memberships upon expirations. This discovery does not back previous studies findings that revealed that less than half of the people had previously renewed their memberships with NHIS and significant others not willing to renew their cards upon expirations [7, 26–28].
A number of barriers were identified by the study to be responsible for the nonrenewal NHIS membership cards. These barriers included forgetfulness, busy schedules, self-medications, procrastination and the choice of spiritual homes which do not require NHIS membership cards. These challenges are in variance with studies established by [7, 16, 22] which reported non affordability of renewal premiums, dissatisfaction of NHIS services, the need to buy drugs outside NHIS accredited facilities, vast distances to health facilities and no transportation fares, NHIS covered drugs are of low quality and feeling being healthy. Again, this study finding is inconsistent with available literature that stated long waiting in queues to renew NHIS memberships due to administrative protocols as barriers to NHIS dropouts and non-renewals . Evidence from the Hohoe Municipality of Ghana in a study carried out by  does not support our findings on the barriers to the renewals of NHIS membership cards. According to another study conducted in Ghana on the informal sector workers also made discoveries that do not support our findings , however, in the rural South – Western Uganda findings from a similar study revealed high premiums as the major barrier . These variations in the barriers to the renewal of NHIS membership cards may be due to differences in the geological locations of the study settings, the sector they find themselves and the caliber of the study participants involved in the study.
Interestingly, there were a significant number of factors that could be used motivate healthcare workers to renew their membership cards. These reasons included: the need to put in place strict measures to curb self-medications, establishment of institutional NHIS offices, at source deductions or deductions from the Controller and Accountant Generals Department (CAGD) for automatic renewals of NHIS membership cards, creation of renewal centers closer to health facilities and education/promotion of NHIS cards renewals. This is inconsistent with a similar study from  that reported on geographical accessibility of accredited health facilities in terms of expansion, stringent monitoring mechanisms on health providers and early reimbursement of health providers. Again, our findings contradict that of another study that proposed that the introduction of instant NHIS membership cards at the point of registration and the electronic renewal methods are likely to alleviate and motivate the protracted registration and renewals process . The high mobile phone penetration in Ghana gives a special chance for NHIA to apply the voice or short text messages as techniques to educate the general public about the procedures of the scheme which can also include sending reminders to NHIS customers whose memberships are nearing expiration to avoid inadvertent loss of memberships; text messages have been confirmed to stay on mobiles phones for longer periods and could remind individuals better and further [1, 31]. Above that, findings from our study on the motivators for renewals of NHIS membership cards are inconsistent with that of . The variations in the motivators for the renewals of NHIS membership cards could be attributed to the fact that there are varied ways of motivating clients and they could be client specific depending on choices coupled with individual and group interests.
It was further revealed that, educational level (tertiary), religious affiliation (Christianity) and marital status (being divorced) were significant predictors of non-renewal of NHIS membership cards. This is consistent with previous studies carried out by [5, 14]. However, it is in contrast with earlier studies by [21, 24] which revealed that educational level, marital status and religious beliefs were insignificant predicators to non-renewal of NHIS membership cards. In addition, our findings on educational level being a significant predictor to NHIS nonrenewal agrees with that of . Again, our findings are inconsistent with other discoveries by  that suggested that educational level and religious affiliation were significant predictors to non-renewal of NHIS membership cards. The results suggest that having a spouse/partner could be beneficial because of the financial assistance obtained from being in a dual-income household, which increases the probability of renewing NHIS membership cards. Those who had attained tertiary education being more likely not to renew their NHIS membership cards compared to those without a formal education may be because at that level of their educational status, they might have accumulated sufficient knowledge on primary prevention of diseases. Hence, no need to subscribe or renew their NHIS memberships. Furthermore, it is possible they have other alternative health insurance policies.