Extending Health Insurance: Effects of the National Health Insurance Scheme in Ghana

There is considerable interest in exploring the potential of health insurance to increase the access to, and the affordability of, health care in Africa. We focus on the recent experience of Ghana, where a National Health Insurance Scheme (NHIS) became law in 2003 and fully implemented from late 2005. Even though there is some evidence of large coverage levels, the effect of the NHIS on health care demand and out-of-pocket expenditures has still not been fully examined. This paper is an attempt to close this gap. Using nationally-representative household data from the Ghana Demographic and Health Survey, we find that the introduction of the NHIS has a positive and significant effect on the utilisation of health care services, although it does have only a weak effect on out-of-pocket expenditure.