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National health insurance and the choice of delivery facility among expectant mothers in Ghana


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.

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  1. In 2017, about 295,000 women died of maternal death worldwide with daily death of 810. About 94% of all maternal deaths occur in low and lower middle-income countries, 66% occur in Sub-Saharan Africa (WHO 2019a). In 2017, Ghana had about 2700 maternal deaths with maternal mortality ratio (MMR) of 308 per 100,000 live births, lifetime risk of maternal death being one in 82 (WHO 2019b). Can Ghana achieve the SDG3 of MMR of 70 by the year 2030?


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The content is solely the responsibility of the authors. The authors are grateful to DHS and the Ghana Statistical Services, for granting permission to use GDHS 2014 and GDHS 2008 datasets.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Richard Agbanyo.

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See Table 5.

Table 5 Factors influencing facility delivery—Conditional Mixed Process (CMP) and multinomial probit regression coefficients–(coefficients)

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Agbanyo, R., Peprah, J.A. National health insurance and the choice of delivery facility among expectant mothers in Ghana. Int J Health Econ Manag. 21, 27–49 (2021).

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  • National health insurance
  • Place of delivery
  • Multinomial endogenous treatment effect model
  • Conditional mixed process
  • Ghana

JEL Classification

  • I13
  • I11
  • B54