he National Health Insurance Scheme (NHIS) was introduced in Ghana in 2003 in an effort to address issues of inequities in financial access to health care. The aim of this study was to determine the trends of health care seeking behaviour by socio-economic status (SES) and out-of-pocket expenditure of OPD visits in Madina Township in Ghana.

A population-based, cross-sectional household survey was carried out in Madina Township in the Ga-East Municipal, Accra, Ghana, using structured questionnaires to obtain information from a random sample of 378 household heads using a two-week recall period.

The study found NHIS enrolment levels in Madina Township to be far below expectations (27.5%). There were disparities in waiting times indicating higher delays of insured patients. Despite the financial protection that the NHIS offers, poor households continue to incur significant costs on health care services. In addition, household perceptions regarding not only costs but also quality of service, severity of illness and proximity were found to influence choice of health services. Household SES continues to exert influence on choice of health services despite the introduction of NHIS. Efforts to improve enrolment and health service utilization must take cognizance of the broader range of factors that may challenge or even erode gains, if just the costs of health care are addressed as an isolated item.