OBJECTIVES: Studies show that Ghana’s National Health Insurance Scheme (NHIS) has increased access to healthcare services and reduced out-of-pocket (OOP) payment. Yet, there are increasing reports of OOP payment due to delays in reimbursement of healthcare provider claims and alleged low NHIS tariffs. In respect of these complaints, this study examined effect of the NHIS on healthcare services and OOP payment using recent data..

METHODS: This is a cross-sectional study using data from the seventh round of the Ghana Living Standard Survey, a nationally representative survey of 14,009 households conducted in 2016/2017. Descriptive analysis and treatment-effects estimation method were applied to examine the data.

RESULTS: Among the 32,229 individuals who responded to the questions on health insurance and healthcare services utilization, 63.7% were insured (card seen); 55.9% were females; and the average age was 25 years (SD=21). The chances of visiting healthcare facility were higher for the insured (card seen) by 4.3 percentage points and insured (card not seen) by 2.3 percentage points, compared to the uninsured. However, the dropouts (previously insured) had a lower probability of visiting healthcare facility by 1 percentage point, compared to the uninsured. Similarly, the chances of utilizing hospitalization services (at least one night) were significantly higher for the insured (card seen) by 8.1 percentage points, insured (card not seen) by 11.6 percentage points, and dropouts by 5.9 percentage points than the uninsured. Besides, the NHIS lowered OOP payment for hospitalization services for the insured (card seen) by US$0.45 and dropouts by US$0.88, compared to the uninsured. It, however, increased that of the insured (card not seen) by US$0.45.

CONCLUSIONS:The NHIS is providing access to healthcare services and reducing OOP payment for the insured. Nonetheless, policy makers need to address reported cases of unauthorized payments at the point of service use to improve utilization and retention of coverage.