The effects of National Health Insurance Scheme on healthcare utilisation, financial protection and health status in Ghana

Abstract

Health insurance is predicted to increase healthcare utilisation, lower out-of-pocket health spending, and improve household health and productivity. This thesis aimed to assess the effects of Ghana’s National Health Insurance Scheme on healthcare utilisation, financial protection and health status of beneficiaries. The data for the study comes from the Ghana Socioeconomic Panel Survey (GSPS) wave 1, 2 and 3 datasets involving a total sample of 31,807 individuals. The study employed the logit model, negative binomial regression model, two-stage residual inclusion (2SRI), the two-part model (i.e., probit model and log-linear model), Heckman selection model, Copula-based Heckman selection model, endogenous switching regression for ordered outcomes and Conditional Mixed Process (CMP) model. The results revealed that NHIS membership improves healthcare utilisation by increasing visits to a health facility and formal care usage. The heterogeneous effects of NHIS on healthcare utilisation further show an increased probability of seeking formal care irrespective of residential status and income. Concerning health facilities visits, the study found increased visitations for the insured rural residents, whereas the probability of visiting a health facility increases for the NHIS members irrespective of income. The Copula-based Heckman sample-selection model was chosen as the preferred model for examining the determining factors of out-of-pocket health spending after a series of examinations of different models. Estimates from the superior Copula-based Heckman sample-selection model indicated that NHIS significantly reduces out-of-pocket health spending at the point of using healthcare services, thereby offering financial protection to its members. The study further found that NHIS membership was associated with decreasing probability of self-reporting lower health status, but rather increases the likelihood of self-reporting good health, suggesting that NHIS membership improves the health status of beneficiaries. The study recommends premiums subsidisation for the poor in the society by the government and other benevolent organisations as such targeted demand-side subsidy will help the country achieve universal health coverage.