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.
Highlights
Increasing equitable access to health care is one of the main challenges African policy makers are facing today
We used propensity score matching (PSM) to limit the potential bias arising from the self-selection into the National Health Insurance Scheme (NHIS). 39.8% of the children have a mother who is enrolled in the NHIS and the mother’s age, marital status, ethnicity, education, occupation, wealth and region of residence are the main correlates of enrolment
We found that NHIS enrollment significantly increased the percentage of children whose mother obtained at least four antenatal care (ANC) visits, had a skilled health care worker present during birth and that were born with a caesarean section
Summary
Increasing equitable access to health care is one of the main challenges African policy makers are facing today. An important constraint to healthcare access derives from the large out-ofpocket payments incurred at the point of use. Health insurance can protect households from the risk of medical expenses which can be large relative to modest incomes [1] and cause households to fall into poverty [2]. The National Health Insurance Scheme (NHIS) implemented in Ghana in 2004 [3,4] is one of the most ambitious health care financing reforms in Sub Saharan Africa (SSA). Ghana has been the first country in SSA to establish a large financial.
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