title: Health insurance and maternal, newborn services utilisation and under-five mortality.
abstract: BACKGROUND
  Ghana's National Health Insurance Scheme (NHIS) was introduced in 2005 as a demand side intervention to remove financial barriers to accessing health services. After almost a decade of implementation, this study aims to investigate the association of NHIS membership with antenatal visits (ANC), postnatal visits (PNC) and under-five mortality, using data from the most recent Multiple Indicator Cluster Survey (MICS).
  
  
  METHODS
  The survey was nationally representative and used a two-stage sample design to produce separate estimates for key indicators for each of the ten regions in Ghana. A generalised linear model (GLM) with binomial-family logit-link was used to estimate the effect of NHIS membership on each of the MNCH service utilisation indicators, adjusting for relevant confounding factors. Using birth history data, the Cox proportional hazard regression model was used to estimate the effect of NHIS membership on the incidence of under-five deaths, adjusted for wealth quintiles and other potential confounders.
  
  
  RESULTS
  The results support the role of health insurance membership in improving access to maternal and child health services, including antenatal care (ANC4+ adjusted OR = 1.94; 95 % CI = [1.28, 2.95]; P < 0.01), and content of antenatal care (adjusted OR = 2.05; 95 % CI = (1.46, 2.90); P < 0.0001). However, the study failed to show evidence of association of NHIS membership and under-five mortality (adjusted hazard rate = 0.86; 95 % CI = [0.64, 1.14]; P = 0.30).
  
  
  CONCLUSIONS
  National health insurance membership is associated with increased access to and utilisation of health care but not with under-five mortality.
authors.affiliation: Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bosomprah
authors.affiliation: Health and Nutrition Department, UNICEF Ghana Office, Accra, Ghana ; Health and Nutrition Department, University of Manchester, Accra, Ghana.
authors.forename: Peter Luigi
authors.initials: PL
authors.lastname: Ragno
authors.affiliation: Health and Nutrition Department, UNICEF Ghana Office, Accra, Ghana.
authors.forename: Clemens
authors.initials: C
authors.lastname: Gros
authors.affiliation: Health and Nutrition Department, UNICEF Ghana Office, Accra, Ghana.
authors.forename: Hari
authors.initials: H
authors.lastname: Banskota
keywords: Health insurance; Maternal; Newborn; and Child health