Maternal healthcare insurance ownership and service utilisation in Ghana: Analysis of Ghana Demographic and Health Survey.

Sanni Yaya,Bishwajit Ghose,Ruoxi Wang,Shangfeng Tang,Feng Da,Uwe Schneider

doi:10.1371/journal.pone.0214841

Sanni Yaya, Bishwajit Ghose + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0214841

Copy DOI

Abstract

ObjectivesPrevious studies have attempted to assess the role of health insurance on health care utilization in African settings. However, there is limited evidence on the effects of health insurance on use of maternal health care. In the present study our objective was to measure the prevalence of insurance ownership, types of services covered by the insurance and the association of insurance ownership with the utilization of respective maternal health services in Ghana.MethodsThis study was based on nationally representative Demographic and Health Survey in Ghana (GDHS 2014) encompassing 4,293 mothers aged 15–49 years. Outcome variables were use of early antenatal care (ANC), facility delivery, and postnatal care (PNC) for mothers and children, and the explanatory variables were insurance coverage for these services. Associations were analysed using logistic regression models whilst controlling for potentially confounding variables.ResultsPrevalence of health insurance ownership was 66.8% (95%CI = 64.5–68.9) with significant socioeconomic disparities. The prevalence was higher particularly among women who were urban residents, had higher educational and wealth status. In general, insurance coverage for services such as ANC, childbirth and postnatal care was higher in rural areas, but that of cash benefit was higher in urban areas. Findings of multivariate analysis indicated that women who had their ANC services covered had significantly higher odds of attending at least one and four ANC visits, as well as receiving PNC for child. Insurance coverage for childbirth services showed significant association with the PNC for child, not with choice of health facility delivery. Women who had cash benefit were twice as likely to use early ANC visit (OR = 2.046, p<0.05), facility delivery (OR = 1.449, p<0.05), and PNC for mother (OR = 1.290, p<0.05).ConclusionOverall prevalence of health insurance coverage has increased since 2008, with significant disparities across demographic and socioeconomic groups. Insurance ownership for different types of maternal health services showed positive association with service uptake, with exceptions for place of delivery, indicating that insurance coverage alone may not be able to promote facility delivery. More studies are required to measure the progress in maternal healthcare utilisation through the insurance programmes.

Highlights

There has been a substantial decline in maternal and child mortality rates since the 1990s
Insurance coverage for services such as antenatal care (ANC), childbirth and postnatal care was higher in rural areas, but that of cash benefit was higher in urban areas
Findings of multivariate analysis indicated that women who had their ANC services covered had significantly higher odds of attending at least one and four ANC visits, as well as receiving postnatal care (PNC) for child

Summary

Introduction

There has been a substantial decline in maternal and child mortality rates since the 1990s. In sub–Saharan Africa, for instance, maternal mortality ratio fell by approximately 45%, unevenly across the countries [1]. This success is largely attributed to the active policy and programmatic efforts propelled by Millennium Development Goals (MDGs) along with the efforts by numerous national and international health and development organisations [1,2,3,4,5]. Low-middle-income countries (LMICs) still account for almost all (99%) of maternal, newborn, and child deaths occurring globally[9]

Objectives

Results

Conclusion