ArticleInternational journal for equity in health2016
Can health insurance protect against out-of-pocket and catastrophic expenditures and also support poverty reduction? Evidence from Ghana's National Health Insurance Scheme.
Article in International journal for equity in health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 7 of them syntheses that pooled it.
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Who cites it
74 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Effects of health insurance on economic burden and health service utilization among people with noncommunicable diseases in low- and middle-income countries: a systematic review.BMC public health · 2026Pooled it
- Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis.Bulletin of the World Health Organization · 2022Pooled it
- Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review.PloS one · 2022Pooled it
- Medical injection and access to sterile injection equipment in low- and middle-income countries: a meta-analysis of Demographic and Health Surveys (2010-2017).International health · 2020Pooled it
- Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review.International journal for equity in health · 2019Pooled it
- Pooled it
- Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review.BMC health services research · 2018Pooled it
- Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda.BMC health services research · 2022Trial
- Assessing intervention effects on healthcare-related financial protection in low- and middle-income countries: a rapid evidence review.Health policy and planning · 2026Review
- Sociodemographic characteristics and healthcare-seeking behaviour of patients with sickle cell disease: a cross-sectional study across five tribal districts in India.Journal of community genetics · 2026Article
- Do publicly funded health insurance schemes reduce out-of-pocket expenditure?: Evidence from India.BMC health services research · 2026Article
- Out-of-pocket healthcare expenditures in older Mexican people based on their social security status.Health policy and planning · 2026Article
- Measuring health financing vulnerability due to reductions in official development assistance: A conceptual framework with empirical application across 47 African countries.PLOS global public health · 2026Article
- Article
- Institutional design features of health insurance subsidy programmes in Africa: a narrative review.International journal for equity in health · 2025Review
- Can supplementary private health insurance reduce poverty vulnerability? Evidence from Shandong Province.BMC public health · 2025Article
- Health insurance coverage, healthcare use, and financial protection amongst people with disabilities in Indonesia: analysis of the 2021 National Socioeconomic Survey.The Lancet regional health. Southeast Asia · 2025Article
- Determinants of antenatal care service utilisation in sub-Saharan Africa: an analysis of demographic and health surveys data (2015-2022).Archives of public health = Archives belges de sante publique · 2025Article
- What influences the impact of health financing reforms? Using qualitative comparative analysis to identify patterns in health financing systems and their effects on financial protection.SSM - health systems · 2025Review
- Making health insurance responsive to citizens: learning from six low-income and middle-income countries.BMJ global health · 2025Review
14 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGhana since 2004, begun implementation of a National Health Insurance Scheme (NHIS) to minimize financial barriers to health care at point of use of service. Usually health insurance is expected to offer financial protection to households. This study aims to analyze the effect health insurance on household out-of-pocket expenditure (OOPE), catastrophic expenditure (CE) and poverty.
methodsWe conducted two repeated household surveys in two regions of Ghana in 2009 and 2011. We first analyzed the effect of OOPE on poverty by estimating poverty headcount before and after OOPE were incurred. We also employed probit models and use of instrumental variables to analyze the effect of health insurance on OOPE, CE and poverty.
resultsOur findings showed that between 7-18 % of insured households incurred CE as a result of OOPE whereas this was between 29-36 % for uninsured households. In addition, between 3-5 % of both insured and uninsured households fell into poverty due to OOPE. Our regression analyses revealed that health insurance enrolment reduced OOPE by 86 % and protected households against CE and poverty by 3.0 % and 7.5 % respectively.
conclusionThis study provides evidence that high OOPE leads to CE and poverty in Ghana but enrolment into the NHIS reduces OOPE, provides financial protection against CE and reduces poverty. These findings support the pro-poor policy objective of Ghana's National Health Insurance Scheme and holds relevance to other low and middle income countries implementing or aiming to implement insurance schemes.
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