Agbanyo Richard, Peprah James Atta
Department of Banking and Finance, University of Professional Studies, Accra, Post Office Box LG149, Legon, Accra, Ghana.
Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana.
Int J Health Econ Manag. 2021 Mar;21(1):27-49. doi: 10.1007/s10754-020-09288-w. Epub 2020 Oct 30.
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.
医疗保险在消除孕产妇医疗保健利用障碍以遏制孕产妇死亡率方面的有效性，尤其是在发展中国家，正日益得到认可。然而，在评估医疗保险对分娩机构选择的影响时，以往的研究要么将所有分娩服务合并在一起并使用二元技术，要么未能解决内生性问题。此外，加纳用于此类分析的数据年份可能无法说明一个令人信服的情况。本研究使用了2014年至2008年加纳人口与健康调查的数据，样本为6319名妇女，并采用具有条件混合过程估计器的多项内生处理效应模型，来检验国家医疗保险计划（NHIS）对加纳分娩机构选择的影响。我们发现，NHIS对卫生系统中不同服务提供者的分娩服务使用情况有不同影响。相对于家庭分娩服务，参保会使使用公立医院、公共诊所和私立卫生机构进行分娩的概率分别提高20.3%、9.1%和2.3%。此外，相对于2008年之前分娩的参保妇女，2008年之后分娩的参保妇女使用公立医院、公共诊所和私立卫生机构进行分娩的可能性分别高出6.3%、4.9%和0.77%。
