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. 2022 May 4;22(1):599.
doi: 10.1186/s12913-022-07964-w.

Health services availability and readiness moderate cash transfer impacts on health insurance enrolment: evidence from the LEAP 1000 cash transfer program in Ghana

Peter Otieno  1 , Gustavo Angeles  2 , Sarah Quiñones  3 , Vincent van Halsema  4 , Jacob Novignon  5 , Tia Palermo  6 ; LEAP 1000 Evaluation Team
Collaborators, Affiliations

Health services availability and readiness moderate cash transfer impacts on health insurance enrolment: evidence from the LEAP 1000 cash transfer program in Ghana

Peter Otieno et al. BMC Health Serv Res. .

Abstract

Background: Expanding health insurance coverage is a priority under Sustainable Development Goal 3. To address the intersection between poverty and health and remove cost barriers, the government of Ghana established the National Health Insurance Scheme (NHIS). Government further linked NHIS with the Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer program by waiving premium fees for LEAP 1000 households. This linkage led to increased NHIS enrolment, however, large enrolment gaps remained. One potential reason for failure to enroll may relate to the poor quality of health services.

Methods: We examine whether LEAP 1000 impacts on NHIS enrolment were moderated by health facilities' service availability and readiness.

Results: We find that adults in areas with the highest service availability and readiness are 18 percentage points more likely to enroll in NHIS because of LEAP 1000, compared to program effects of only 9 percentage points in low service availability and readiness areas. Similar differences were seen for enrolment among children (20 v. 0 percentage points) and women of reproductive age (25 v. 10 percentage points).

Conclusions: We find compelling evidence that supply-side factors relating to service readiness and availability boost positive impacts of a cash transfer program on NHIS enrolment. Our work suggests that demand-side interventions coupled with supply-side strengthening may facilitate greater population-level benefits down the line. In the quest for expanding financial protection towards accelerating the achievement of universal health coverage, policymakers in Ghana should prioritize the integration of efforts to simultaneously address demand- and supply-side factors.

Trial registration: This study is registered in the International Initiative for Impact Evaluation's (3ie) Registry for International Development Impact Evaluations ( RIDIE-STUDY-ID-55942496d53af ).

Keywords: Ghana; Health insurance; Health services; Social protection; Supply-side.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Health facility characteristics by tertile of service quality
See this image and copyright information in PMC

References

    1. Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. The Lancet. 2012;380(9845):933–943. doi: 10.1016/S0140-6736(12)61147-7. - DOI - PubMed
    1. Sambo LG, Kirigia JM. Investing in health systems for universal health coverage in Africa. BMC Int Health Hum Rights. 2014;14(1):1–22. doi: 10.1186/s12914-014-0028-5. - DOI - PMC - PubMed
    1. Alsan M, Schoemaker L, Eggleston K, Kammili N, Kolli P, Bhattacharya J. Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis. Lancet Infect Dis. 2015;15(10):1203–1210. doi: 10.1016/S1473-3099(15)00149-8. - DOI - PMC - PubMed
    1. Lee JT, Hamid F, Pati S, Atun R, Millett C. Impact of noncommunicable disease multimorbidity on healthcare utilisation and out-of-pocket expenditures in middle-income countries: cross sectional analysis. PLoS ONE. 2015;10(7):e0127199. doi: 10.1371/journal.pone.0127199. - DOI - PMC - PubMed
    1. Ifeagwu SC, Yang JC, Parkes-Ratanshi R, Brayne C. Health financing for universal health coverage in Sub-Saharan Africa: a systematic review. Glob Health Res Policy. 2021;6(1):1–9. doi: 10.1186/s41256-021-00190-7. - DOI - PMC - PubMed