Published in PLOS One on 2026-05-14, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Angela Nana Esi Ackon, Hubert Amu, Martin Amogre Ayanore, Miquel Vall-llosera Camps, Charles Ezenduka
Source: PLOS One • DOI 10.1371/journal.pone.0348971
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Out-of-pocket (OOP) payments are a common component of healthcare financing in many low-and middle-income countries including Ghana. Despite implementation of the National Health Insurance Scheme in Ghana which is expected to protect against catastrophic OOP payments, patients still make some form of payments with its attendant negative implications for improved health status. We examined the prevalence and self-reported effects of OOP payments among hypertensive patients insured under the National Health Insurance Scheme attending a referral hospital in Hohoe, Ghana.
This was a cross-sectional study conducted among 389 hypertensive patients between February and May 2022 using a structured questionnaire. Data collected were analysed using Stata software version 15. We employed descriptive statistics and logistic regression in analysing the data. Statistical significance was considered at p < 0.05.
A total of 97.2% respondents made OOP payments in receiving healthcare with 97.1% of those who made such payments having made them at the point of receiving drugs. Difficulty in making OOP payments was reported by 29.1% of the respondents and this was associated with ever borrowing money to cover health expense (aOR=2.52; 95% CI: 1.31–4.88; p = 0.006), OOP payments affecting hospital attendance (aOR=5.52; 95% CI: 2.74–11.11; p < 0.001) and having an alternative form of treating hypertension (aOR=2.93; 95% CI: 1.60–5.38; p = 0.001).
OOP payments are widespread in the utilisation of healthcare for hypertensive patients. This raises concerns about progress towards the attainment of Sustainable Development Goals (SDGs) 3.4 which seeks to control non-communicable diseases and SDG 3.8 which seeks to ensure universal health coverage. Medications or drugs are the major healthcare services for which individual hypertensive patients made OOP payments thus highlighting the need ensure availability and accessibility of drugs to meet the global targets of SDG 3 and due to the long-term treatment requirements of hypertension.
Introduction
Out-of-pocket (OOP) payments lead to financial and non-financial barriers in healthcare access [1] and such payments are a common component of healthcare financing in low- and middle-income countries (LMICs). OOP expenditure by households is reported as a regressive pathway to financing healthcare since it leads to the risk of catastrophic payments by households who do not have adequate financial protection [2]. OOP payments refer to payments, both formal and informal, that are made while accessing healthcare and these include payment for medical supplies, consultation fees and payment for laboratory tests [1]. It also includes any direct remittance by households to healthcare providers which is primarily intended to restore or enhance health of an individual or group [3].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Angela Nana Esi Ackon, Hubert Amu, Martin Amogre Ayanore, Miquel Vall-llosera Camps, Charles Ezenduka. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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