ReachUHC: A randomized controlled trial study protocol of a mobile phone-based reminder and automatic renewal intervention to increase health insurance renewal rates in Kumasi, Ghana

BackgroundSince the Ghanaian National Health Insurance Scheme (NHIS) was introduced in 2004, coverage rates have remained low, despite affordable premiums and payment exemptions for minor, senior, poor and pregnant individuals. While 82% of the population have registered with the NHIS, many fail to complete the annual renewal and thus lose their coverage. A mobile renewal service introduced in 2018 simplified the previously cumbersome renewal procedure. Still, 40% of active member experience gaps in coverage in a given year, and 19% fail to renew at all. Baseline research suggests that forgetfulness is a major barrier to renewal. Methods342,818 NHIS members from Kumasi will be randomized into the reminder, autorenewal or control groups. The reminder arm receives SMS prompts to complete the mobile renewal process and payment before expiration. The autorenewal arm is eligible to sign up for automatic renewal and give the NHIS permission to deduct the premium from their mobile money account, and will receive SMS prompt to do so. The intervention lasts 6 months. NHIS routine data will be used to evaluate the effect of the interventions on renewals. A follow-up survey household survey in Kumasi will evaluate additional aspects user experience. DiscussionImproving insurance retention has the potential to substantially increase health insurance coverage rates, as 45% of the Ghanaians currently have expired insurance. Assessing these tools will identify enabling factors and barriers of the intervention and inform the transferability of the intervention to other health insurance systems in sub-Saharan African countries. Trial registrationPan African Clinical Trials Registry (PACTR)