Does NHIS Enrollment Increase Maternal Healthcare Utilization? Evidence from the Ghana Demographic and Health Survey (GDHS)

Abstract

Purpose: This research aims to examine the effects of Ghana’s National Health Insurance Scheme (NHIS) on maternal healthcare utilization.
 Originality: The most of the previous studies examined the association between health insurance enrollment and the use of maternal healthcare service. However, our paper investigated the causal relationship of the NHIS enrollment and maternal healthcare utilization based on the latest available dataset of 2014 Ghana Demographic and Health Survey (GDHS), using the Propensity Score Matching (PSM). Another difference between our analysis and previous papers is that control variables were selected from a theory-based framework.
 Methodology: To address selection bias and move towards more causal estimates, PSM was conducted for analysis.
 Result: The NHIS increased 9.5% points of access to at least four antenatal care visits. It also led to the positive effects on facility-based delivery after at least four antenatal care visits, which increased by 11% points. Lastly, women enrolled in the NHIS were significantly 13.4% points more likely to have the first prenatal check in a trimester.
 Conclusions and Implication: Our results imply that broadening access to the NHIS offering coverage of maternal healthcare is needed to encourage women to use maternal healthcare, at the level of minimum recommended standards. On the other hand, since the endogeneity problem is still an issue despite using PSM, the overestimation of the results in our study needs to be considered.