The Effects of Ghana's National Health Insurance Scheme on Maternal and Infant Health Care Utilization.
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.
Erasmus University Rotterdam, Institute for Health Policy & Management, Rotterdam, South Holland, The Netherlands.|Harvard University, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, United States of America.
Igna
I
Bonfrer
Erasmus University Rotterdam, Institute for Health Policy & Management, Rotterdam, South Holland, The Netherlands.
Lyn
L
Breebaart
Erasmus University Rotterdam, Institute for Health Policy & Management, Rotterdam, South Holland, The Netherlands.
Ellen
E
Van de Poel
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D002648:Child; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005869:Ghana; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000706:statistics & numerical data*; D019458:Insurance Coverage / Q000191:economics; D008425:Maternal Behavior; D009313:National Health Programs / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors