National health insurance and the choice of delivery facility among expectant mothers in Ghana
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National health insurance and the choice of delivery facility among expectant mothers in Ghana Richard Agbanyo1 · James Atta Peprah2 Received: 10 August 2018 / Accepted: 17 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The effectiveness of health insurance in removing barriers to the utilisation of maternal healthcare in order to curb maternal mortality especially in developing countries is gaining ground. However, in assessing the effects of health insurance on choice of delivery facilities, previous studies either put all delivery services together and used binary techniques or failed to address endogeneity problem. Moreover, the age of data used for such analysis in Ghana may not tell a convincing story. This study used data from the 2014 to 2008 Ghana Demographic and Health Surveys with a sample of 6319 women and employed multinomial endogenous treatment effects models with Conditional Mixed Process estimator to examine the effects of national health insurance scheme (NHIS) on the choice delivery facility in Ghana. We found that NHIS has varied effects on the use of delivery services across service providers in the health system. Relative to home delivery services, being insured increases the probability of using public hospitals, public clinics and private health facilities for delivery by 20.3 percent, 9.1 percent and 2.3 percent respectively. Moreover, relative to an insured woman who gave birth before 2008, her counterpart who gave birth after 2008 is 6.3 percent, 4.9 percent and 0.77 percent more likely to use public hospitals, public clinics and private health facilities respectively for delivery. Keywords National health insurance · Place of delivery · Multinomial endogenous treatment effect model · Conditional mixed process · Ghana JEL Classification I13 · I11 · B54
* Richard Agbanyo [email protected]; [email protected] 1
Department of Banking and Finance, University of Professional Studies, Accra, Post Office Box LG149, Legon, Accra, Ghana
2
Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana
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Vol.:(0123456789)
R. Agbanyo, J. A. Peprah
Introduction Timely utilisation of quality maternal healthcare provided by trained personnel is often deemed a panacea for maternal mortality which has bedevilled many developing countries including Ghana1 (Agbanyo 2020; Bullough et al. 2005; Wado 2013; WHO 2014, 2019b). However, the utilisation of maternal healthcare remains low in these countries due to several factors (Agbanyo 2019; Wang et al. 2017). This situation can be explained by both the standard human capital model of health (Grossman 1972) and the Behavioural Healthcare Utilisation Model (Anderson 1995). According to Grossman, health stock depreciates but can be replenished by spending money or time on health investments (e.g. purchasing health insurance or healthcare) or further depleted through disinvestments (Courtemanche et al. 2017; Grossman 1972). Anderson (1995) also ident
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