Determinants of health insurance enrollment and health expenditure in Ghana: an empirical analysis.

This paper analyzes the determinants of health insurance enrollment and health expenditure in Ghana using micro data from wave 7 of the Ghana Living Standards Survey (GLSS 7) with emphasis on the role of risk preferences and the availability of health facilities in one's own community. It is possible to analyze the determinants of health insurance enrollment in Ghana because its public health insurance system (the National Health Insurance Scheme or NHIS) is, in theory, mandatory, but is, in actual practice, voluntary, with only about 40% of the population enrolled in the scheme. Our empirical findings show that risk preferences have a significant impact on health insurance enrollment, with risk averse individuals being significantly more likely than other households to enroll in health insurance. Moreover, our findings also show that very poor households are significantly more likely to enroll in health insurance than other households, perhaps because they are exempt from paying premiums for health insurance. Finally, our findings also show that the availability of health facilities in one's own community significantly decreases expenditures on health care. Highlights: Ghana's National Health Insurance Scheme is, in principle, mandatory but only 40% of households are enrolled. Ghana's National Health Insurance Scheme is pro-poor, with higher enrollment rates for the very poor. Risk-averse households are more likely to enroll in Ghana's National Health Insurance Scheme than other households, as expected. Enrollees in Ghana's National Health Insurance Scheme do not have lower out-of-pocket health expenditures than other households. Proximity to health facilities enables households in Ghana to reduce health expenditures. [ABSTRACT FROM AUTHOR]