The Effect of Insurance Enrollment on Maternal and Child Health Care Utilization: The Case of Ghana

40 Pages Posted: 5 Mar 2016

See all articles by Gissele Gajate-Garrido

Gissele Gajate-Garrido

affiliation not provided to SSRN

Clement Ahiadeke

University of Ghana - Institute of Statistical, Social, and Economic Research (ISSER)

Date Written: December 30, 2015

Abstract

Access to and use of health services are concerns in poor countries. If implemented correctly, health insurance may help solve these concerns. Due to selection and omitted variable bias, however, it is difficult to determine whether joining an insurance scheme improves medical care-seeking behaviors. This paper uses representative data for the whole country of Ghana and an instrumental variable approach to estimate the causal impact on healthcare use of participating in Ghana’s National Health Insurance Scheme. Idiosyncratic variations in membership rules at the district level provide exogenous variation in enrollment. The instrument is the existence of nonstandard verification methods to allow enrollment of children. Using the 2008 Ghana Demographic and Health Survey and a census of all district insurance offices, this paper finds that insurance membership increases the probability of (1) seeking higher-quality (but no greater quantity of) maternal services and (2) parents’ becoming more active users of child curative care. Instrumental variable estimates are larger than ordinary least squares ones, indicating that “compliers” have much higher returns to being insured than the average participant. Results are robust to several validity checks; this paper shows that the instrument is indeed idiosyncratic and proves that government officials did not establish less-cumbersome membership rules in districts with worse initial indicators.

Keywords: Ghana; west Africa; Africa south of Sahara; Africa; health insurance; child health; maternal health; heterogeneous treatment effects

JEL Classification: D10; I10; O10

Suggested Citation

Gajate Garrido, Gissele and Ahiadeke, Clement, The Effect of Insurance Enrollment on Maternal and Child Health Care Utilization: The Case of Ghana (December 30, 2015). IFPRI Discussion Paper 1495, Available at SSRN: https://ssrn.com/abstract=2741917 or http://dx.doi.org/10.2139/ssrn.2741917

Gissele Gajate Garrido (Contact Author)

affiliation not provided to SSRN

Clement Ahiadeke

University of Ghana - Institute of Statistical, Social, and Economic Research (ISSER) ( email )

PO Box 25
Legon, Accra LG
Ghana

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