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; Gustavo Angeles; Sarah Quiñones; Vincent van Halsema; Jacob Novignon; Tia Palermo; LEAP 1000 Evaluation Team

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

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

Authors

Peter Otieno¹, Gustavo Angeles², Sarah Quiñones³, Vincent van Halsema⁴, Jacob Novignon⁵, Tia Palermo⁶; LEAP 1000 Evaluation Team

Collaborators

LEAP 1000 Evaluation Team:
Tia Palermo, Richard de Groot, Elsa Valli, Isaac Osei-Akoto, Clement Adamba, Joseph K Darko, Robert Darko Osei, Francis Dompae, Nana Yaw, Sudhanshu Handa, Clare Barrington, Sara Abdoulayi, Gustavo Angeles, Averi Chakrabarti, Frank Otchere, Akalpa J Akaligaung, Raymond Aborigo

Affiliations

¹ African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya.
² Department of Maternal and Child Health, UNC Gillings School of Global Public Health, 400 Meadowmont Circle CB #3446, Chapel Hill, NC, USA.
³ Department of Epidemiology and Environmental Health, University at Buffalo, SUNY, 270 Farber Hall, Buffalo, NY, USA.
⁴ UNICEF Ghana, P.O. Box 5051, 4-8th Rangoon Close, Accra, Ghana.
⁵ Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁶ Department of Epidemiology and Environmental Health, University at Buffalo, SUNY, 270 Farber Hall, Buffalo, NY, USA. tiapaler@buffalo.edu.

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.

MeSH terms

Adult
Child
Female
Ghana
Health Services Accessibility*
Humans
Insurance, Health*
National Health Programs
Universal Health Insurance

Abstract

MeSH terms

Grants and funding