The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda

Abstract

While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage—Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care.

Access to Maternal Healthcare Services under the National Health Insurance Policy in the Upper West Region, Ghana

“…Conversely, 93% of the respondents indicated that they completed the four mandatory ANC attendances in the Wa West District while the remainder did not fulfil it. This compares with the findings made by Wang et al [28] that the majority of pregnant women reported at least one antenatal care visit in Ghana.…”

“…Still, studies that relate to access to maternal healthcare under Ghana's NHIS appear to ignore rural idiosyncrasies associated with access to maternal healthcare services. Using 2008 DHS data, Wang et al [28] examine the impact of NHIS coverage on access to maternal healthcare services in Ghana and came to the conclusion that majority of pregnant women reported at least one antenatal care visit and facility-based delivery. The study presented a national picture but fell short of a discussion of access to maternal healthcare services in rural areas.…”

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).…”

Effects of health insurance on birth weight in Mexico

“…Several studies have found that access to and utilization of prenatal care increased substantially due to the expansion of insurance coverage (Currie & Gruber, 1996a, 1996bMensah, Oppong, & Schmidt, 2010;Wang, Temsah, & Mallick, 2017). Several studies have found that access to and utilization of prenatal care increased substantially due to the expansion of insurance coverage (Currie & Gruber, 1996a, 1996bMensah, Oppong, & Schmidt, 2010;Wang, Temsah, & Mallick, 2017).…”

“…One of the recommended policies to increase access to health care is the expansion of insurance coverage. Several studies have found that access to and utilization of prenatal care increased substantially due to the expansion of insurance coverage (Currie & Gruber, 1996a, 1996bMensah, Oppong, & Schmidt, 2010;Wang, Temsah, & Mallick, 2017). Prior research has argued that policies that increase prenatal care are strongly correlated with infant health, and therefore, expansion of health insurance program is likely to improve infant health through the increased use of prenatal care (Currie & Gruber, 1996a, 1996bHanratty, 1996).…”