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The Impact of Ghana’s National Health Insurance on Psychological Distress



Poor mental health is among the growing number of noncommunicable diseases in low- and middle-income countries. Despite poor mental health accounting for an already considerable and growing burden of disease in many low- and middle-income countries, policy action to confront the challenge has been limited, at both international and national levels. Recently, several low- and middle-income countries have embarked on the journey toward universal health coverage by expanding their public health insurance provision, with the ultimate objective of improving population health, in addition to other health system objectives. Mental health interventions typically may not have been specifically covered in the publicly funded benefit package, and this raises the question of whether, and if so, by how much, the expansion of public health insurance may have directly or indirectly contributed to improved mental health.


We assessed the impact of Ghana’s implementation of national health insurance on psychological distress.


Our study used the first wave of the 2009–2010 Ghana Social Economic Panel survey, including 10,007 respondents. We employed instrumental variable and propensity score matching methods to estimate the causal impact of health insurance on psychological distress, measured by the Kessler Psychological Distress Scale (K10). Higher K10 values indicate greater psychological distress.


The median K10 score in Ghana was 16 (P < 0.001), with a minimum of 10 (P < 0.001) and a maximum of 45 (P < 0.001). The results from the instrumental variable estimations, without matching, indicated that the K10 score for the insured was 11.8% lower (P < 0.001) than that of the uninsured. After running the instrumental variable regression on the matched sample, the K10 score for the insured was 10.6% (P < 0.001) lower than that of the uninsured. Similarly, the estimates based on propensity score matching indicated that the insured had a lower K10 score (− 0.023; P < 0.05). Furthermore, the beneficial impact of health insurance on psychological distress is larger for wealthier than poorer insurance members and varies across regions in Ghana. The findings were robust to the various estimation methods.


This study suggests that having health insurance is associated with reduced psychological distress and hence improved mental health, even though mental illness treatment or prevention were at best only partially covered by the National Health Insurance Scheme in Ghana.

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Fig. 1

Data availability

Data used in the study is publicly available at the World Bank website:


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We are grateful to Professor Andrew Jones, Department of Economics, University of York, for his insightful comments and suggestions to improve the paper.

Author information




GCC conceived the idea, led the data analysis, interpretation, and drafting of the manuscript under the supervision of MS and RMS as part of GCC thesis. MS and RMS supported the data interpretation and writing of the paper. All authors reviewed and approved the final version of the manuscript.

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Correspondence to Gowokani Chijere Chirwa.

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This study received no funding, it is part of the PhD thesis of the corresponding author.

Conflict of interest

Gowokani Chijere Chirwa, Marc Suhrcke, Rodrigo Moreno-Serra declare that they have no conflict of interest.

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Chirwa, G.C., Suhrcke, M. & Moreno-Serra, R. The Impact of Ghana’s National Health Insurance on Psychological Distress. Appl Health Econ Health Policy 18, 249–259 (2020).

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