ESSAYS IN ECONOMICS OF HEALTH - A DEVELOPING COUNTRY PERSPECTIVE

The concept of health insurance (HI) is relatively new in the developing world. Meanwhile among countries experimenting HI, there is a dearth of empirical studies regarding the impact of the HI scheme on healthcare expenditure, particularly in Sub Saharan African (SSA). This study provides an insight into how Ghana is using her health insurance scheme; the country's major social protection programme, to impact out-of-pocket (OOP) healthcare expenditure and facility utilisation. The policy impact is estimated by using difference-in-difference (DID) estimation strategy. The analysis also takes into account self selection into the HI programme by using propensity score matching to create a comparable control group. The use of DID estimation means that the impact estimated here relates to the effect of the HI only on those covered by the scheme (average treatment effect on the treated). Generally the results in the full set model show that the HI scheme is serving as a cushion against the burden of OOP healthcare expenditure in Ghana. Meanwhile, the outcome by gender indicates that the magnitude of the benefits derived from the scheme is only marginally higher in the female sample. Finally, the insured are found to be more likely to seek healthcare from appropriate heath facilities than their uninsured counterparts. Given that the HI scheme is criticised for its piece-meal implementation, to achieve improvements in the health of all, the findings in this chapter is an indication for policy makers to introduce some form of incentives to encourage those in the informal sector to enrol. Keywords: health insurance, healthcare expenditure, utilisation, Ghana JEL: I13