Health Insurance Provision and Women's Healthcare Utilization: Evidence from the National Health Insurance Scheme in Ghana

Abstract

We use the Demographic and Health Survey to study the healthcare utilization effects of Ghana’s 2004 adoption of a national health insurance scheme (NHIS), covering over 95% of medical expenditures. First, we find that self-reported participation in the NHIS increases twelve-month healthcare visits by 32 percentage points using the timing of the rollouts across districts as an instrument. We also show that the positive effect is larger for less-educated, poor, and rural women. Second, we find that the NHIS increases deliveries in health facilities and prenatal care visits by 6 and 7 percentage points, respectively, using a difference-in-differences strategy and women from rural Nigeria as the control group. Together, these findings are consistent with evidence from similar programs in developed countries despite numerous implementation challenges and relatively low take-up of the NHIS.