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Comparative study of the effect of National Health Insurance Scheme on use of delivery and antenatal care services between rural and urban women in Ghana

Author

Listed:
  • Raymond Elikplim Kofinti

    (University of Cape Coast)

  • Emmanuel Ekow Asmah

    (University of Cape Coast)

  • Edward Kwabena Ameyaw

    (University of Technology Sydney)

Abstract

Background Despite the focus of the National Health Insurance Scheme (NHIS) to bridge healthcare utilisation gap among women in Ghana, recent evidence indicates that most maternal deaths still occur from rural Ghana. The objective of this study was to examine the rural-urban differences in the effects of NHIS enrolment on delivery care utilisation (place of delivery and assistance at delivery) and antenatal care services among Ghanaian women. Methods A nationally representative sample of 4169 women from the 2014 Ghana Demographic and Health Survey was used. Out of this sample, 2880 women are enrolled in the NHIS with 1229 and 1651 being urban and rural dwellers, respectively. Multivariate logistic and negative binomial models were fitted as the main estimation techniques. In addition, the Propensity Score Matching technique was used to verify rural-urban differences. Results At the national level, enrolment in NHIS was observed to increase delivery care utilisation and the number of ANC visits in Ghana. However, rural-urban differences in effects were pronounced: whereas rural women who are enrolled in the NHIS were more likely to utilise delivery care [delivery in a health facility (OR = 1.870; CI = 1.533–2.281) and assisted delivery by a medical professional (OR = 1.994; CI = 1.631–2.438)], and have a higher number of ANC visits (IRR = 1.158; CI = 1.110–1.208) than their counterparts who are not enrolled, urban women who are enrolled in the NHIS on the other hand, recorded statistically insignificant results compared to their counterparts not enrolled. The PSM results corroborated the rural-urban differences in effects. Conclusion The rural-urban differences in delivery and antenatal care utilisation are in favour of rural women enrolled in the NHIS. Given that poverty is endemic in rural Ghana, this positions the NHIS as a potential social equaliser in maternal health care utilisation especially in the context of developing countries by increasing access to delivery care services and the number of ANC visits.

Suggested Citation

  • Raymond Elikplim Kofinti & Emmanuel Ekow Asmah & Edward Kwabena Ameyaw, 2022. "Comparative study of the effect of National Health Insurance Scheme on use of delivery and antenatal care services between rural and urban women in Ghana," Health Economics Review, Springer, vol. 12(1), pages 1-19, December.
    • Handle: RePEc:spr:hecrev:v:12:y:2022:i:1:d:10.1186_s13561-022-00357-z
    DOI: 10.1186/s13561-022-00357-z
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    References listed on IDEAS

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    1. United Nations UN, 2015. "Transforming our World: the 2030 Agenda for Sustainable Development," Working Papers id:7559, eSocialSciences.
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    1. Kofinti, Raymond Elikplim & Koomson, Isaac & Paintsil, Jones Arkoh & Ameyaw, Edward Kwabena, 2022. "Reducing children's malnutrition by increasing mothers' health insurance coverage: A focus on stunting and underweight across 32 sub-Saharan African countries," Economic Modelling, Elsevier, vol. 117(C).
    2. Raymond Elikplim Kofinti & Josephine Baako-Amponsah & Prince Danso, 2023. "Household National Health Insurance Subscription and Learning Outcomes of Poor Children in Ghana," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 16(1), pages 357-394, February.

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