National health insurance, women’s autonomy and maternal healthcare utilisation in Ghana

Abstract

The effectiveness of health insurance and women’s autonomy 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, studies either put all facility-based delivery services together and compare with home care or fail to address endogeneity problem. Moreover, the connections among health insurance, autonomy and maternal healthcare has not been established while the age of data used for such analysis in Ghana may not tell convincing stories. This study used pooled data from the 2014 and 2008 Ghana Demographic and Health Surveys. With a sample of 8,805 women, demand for national health insurance scheme (NHIS) before and after 2008 was analysed using multivariate logistic regression. The study also employed multinomial endogenous treatment effects model in Conditional Mixed Process framework to examine the effects of NHIS on the choice of facility-based delivery services relative to home care with a sample of 6,319 women. Finally, Structural Equation Modelling was employed to study the effects of women’s autonomy on desired maternal healthcare and analysed the mediation. It was found that NHIS enrolment increased significantly after 2008. Moreover, the NHIS variable is endogenous, has varied effects on the use of facility-based delivery services relative to home care and it also mediates autonomy and maternal healthcare. It is recommended that means of registration at health facilities for expectant mothers be provided. Moreover, when assessing the effects of health insurance on maternal healthcare, researchers need to separate types of health facilities and consider the endogeneity of health insurance.