The complex association of health insurance and maternal health services in the context of a premium exemption for pregnant women

A case study in Northern Ghana

Bibliographic Data

ID11490170
AuthorsJemima A Frimpong (0000-0002-7393-3085, Columbia University, corresponding author), Helleringer (0000-0002-5921-9651, Columbia University), Stephane Helleringer, John Koku Awoonor‐Williams (0000-0002-1094-8212, Columbia University), John Koku Awoonor-Williams, Thomas Aguilar (Columbia University), Jonathan F Phillips (0000-0002-6720-7204, Columbia University), James F Phillips, Francis Yeji (Columbia University)
Year2014
Volume29
Issue8
Pages1043-1053
Publication date2014-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czt086
PMID24262280
OpenAlexW2119772757
LanguageEN
Citations received4
References cited44

BACKGROUND: Health insurance premium exemptions for pregnant women are a strategy to increase coverage of maternal health services in sub-Saharan countries. We examine health insurance registration among pregnant women before or after the introduction of a premium exemption, and test whether registration increases utilization of maternal health services. METHODS: Data were drawn from a retrospective cohort study of 1641 women having given birth between January 2008 and August 2010 in two impoverished districts of Northern Ghana. Among those, 1411 became pregnant after premium exemption was adopted in July 2008. We compared registration rates before and after the exemption. We used logistic regressions to measure the association between insurance registration and receipt of essential maternal health interventions in the context of the premium exemption. We tested whether this association varied across levels of the health system [e.g. hospitals and health centres (HCs) vs community health compounds (CHC)]. RESULTS: Health insurance registration increased significantly among pregnant women after adoption of the premium exemption. Coverage of clinical and diagnostic services was high, but antenatal care (ANC) clients received only partial counselling about safe motherhood (e.g. pregnancy-related danger signs). Three out of four clients who sought ANC in hospitals and HCs delivered at a health facility vs. slightly more than 50% among clients of CHC. In hospitals and HCs, National Health Insurance Scheme (NHIS) registration was associated with higher quality of services. In CHCs, NHIS registrants received fewer diagnostic tests, were less extensively counselled about safe motherhood and were less likely to be vaccinated against tetanus toxoid than non-registered clients. Among CHCs clients, being a NHIS registrant was however associated with an increased likelihood of delivering at a health facility. CONCLUSIONS: In the context of premium exemptions, association of health insurance with use of maternal health services, and quality of services received, depends on place where pregnant women seek ANC.

Business · Context (archaeology) · Economic growth · Environmental health · Family medicine · Geography · Health care · Health facility · Health services · Logistic regression · Medicaid · Population · Psychological intervention · Receipt · Global Maternal and Child Health · Healthcare Policy and Management · Healthcare Systems and Reforms · Medicine · Nursing