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Int J Health Care Finance Econ (2014) 14:385406 DOI 10.1007/s10754-014-9155-8
The effect of social health insurance on prenatal care: the case of Ghana
Stephen O. Abrokwah Christine M. Moser
Edward C. Norton
Received: 24 November 2013 / Accepted: 1 August 2014 / Published online: 21 August 2014 Springer Science+Business Media New York 2014
Abstract Many developing countries have introduced social health insurance programs to help address two of the United Nations millennium development goalsreducing infant mortality and improving maternal health outcomes. By making modern health care more accessible and affordable, policymakers hope that more women will seek prenatal care and thereby improve health outcomes. This paper studies how Ghanas social health insurance program affects prenatal care use and out-of-pocket expenditures, using the two-part model to model prenatal care expenditures. We test whether Ghanas social health insurance improved prenatal care use, reduced out-of-pocket expenditures, and increased the number of prenatal care visits. District-level differences in the timing of implementation provide exogenous variation in access to health insurance, and therefore strong identication. Those with access to social health insurance have a higher probability of receiving care, a higher number of prenatal care visits, and lower out-of-pocket expenditures conditional on spending on care.
Keywords Prenatal care Social health insurance Two-part model
JEL Classication I13 I18 O12
S. O. Abrokwah (B)
Swiss Reinsurance America Holding Corp, 175 King st, Armonk, NY, USA e-mail: [email protected]; [email protected]
C. M. MoserDepartment of Economics, Western Michigan University, 1903, W. Michigan Ave, Kalamazoo, MI, USAe-mail: [email protected]
E. C. NortonDepartment of Economics and Health Management & Policy, University of Michigan & NBER, 1415 Washington Heights, M3108 SPH II, Ann Arbor, MI 48109, USAe-mail: [email protected]
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Introduction
Slightly more than half of all maternal deaths occur in Sub-Saharan Africa. For example, in Ghana, the maternal mortality ratio in 2005 was estimated at 560 maternal deaths per 100,000 live births, compared to 12.7 maternal deaths per 100,000 live births in the US (World Health Organization 2007). A Ghanaian womans risk of dying from treatable or preventable complications of pregnancy and childbirth over the course of her lifetime is about 1 in 45, compared to 1 in 7,300 in the developed countries. This is partly due to a lack of adequate...