The Effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilization

Abstract

Increasing equitable access to health care is a main challenge African policy makers are facing. The Ghanaian government implemented the National Health Insurance Scheme in 2004 and the aim of this study is to evaluate its early effects on maternal and infant healthcare use. We exploit data on births before and after the intervention and apply propensity score matching to limit the bias arising from self-selection into the health insurance. About forty percent of children had a mother who is enrolled in this insurance. The scheme significantly increased the proportion of pregnancies with at least four antenatal care visits with 7 percentage points and had a significant effect on attended deliveries (10 percentage points). Caesarean sections increased (6 percentage points) and the number of children born from an unwanted pregnancy decreased (7 percentage points). Insurance enrollment had almost no effect on child vaccinations. Among the poorest forty percent of the sample, the effects of the scheme on antenatal care and attended deliveries were similar. However, the effects of the scheme on caesarean sections were about half the size (3 percentage points) and the reduction in unwanted pregnancies was larger (10 percentage points) compared to the effects in the full sample. We conclude that in the first years of operation, the National Health Insurance Scheme had a modest impact on the use of antenatal and delivery care. This is important for other African countries currently introducing or considering a national health insurance as a means towards universal health coverage.

Evaluating health service coverage in Ghana’s Volta Region using a modified Tanahashi model

“…In 2007, this policy was formally integrated into the NHIS, which also expanded free ANC coverage from public health facilities only to all public and accredited private and faith-based health-care providers [28]. This was found to significantly increase the percentage of children whose mothers obtained at least four ANC visits [29].…”

Does Public Health Insurance Increase Maternal Health Care Utilization in Egypt?

“…Also, individuals with insurance are more likely to be from high‐income groups, educated, and from urban areas. These selection factors complicate the comparison of the insured and uninsured women and could cause bias unless they are carefully controlled for (Gertler et al ., ; Bonfrer, Breebaart, & Van de Poel, ; Wang, Temsah, & Mallick, ). We conduct a propensity score matching (PSM) analysis to limit the bias due to confounding factors when estimating the treatment effect by comparing outcomes between the treatment (the insured) and the artificial control groups (the uninsured).…”

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“…At the national level, family planning demand satisfied showed the least likelihood of reaching its target and the reason could be attributed to the fact that this service is not covered under NHIS but implemented through a government vertical program [19] and this pattern is consistent with a previous study [20]. The low uptake of family planning can be explained by many facets such as misconception, stigma, lack of knowledge, religious abhorrence, spousal disapproval, and inaccessibility [21].…”

“…Furthermore, a study done in rural Ghana found that enrollment into NHIS is 2.5 times more among the rich than the poor [29]. This deviates from NHIS’ original equity goal, which was to increase affordability and utilization of health services especially among the poor and vulnerable population [19]. If the poor are not insured, there is an increased likelihood of illnesses resulting in worse health status and further impoverishment.…”