Evaluating The Impact Of National Health Isurance Scheme On Antenatal Care Attendance Among Pregnant Women In Ghana: A Propensity Score Matching Analysis.

ABSTRACT Introduction: Antenatal Care Attendance (ANC) is a very vital issue to consider when dealing with matters of maternal mortality. Maternal mortality, a possible consequence of infrequent or lack of antenatal care attendance. Ghana‟s maternal mortality rate is still unacceptably high, 319 deaths per 100,000 live births. Women receiving antenatal care from a skilled provider has increased steadily over the past two and a half decades from 82% in 1982 to 97% in 2014. But how much of this change relative to ANC could be attributed to NHIS policy is largely unknown. It is in this direction that this present study sought to evaluate the impact of National Health Insurance on antenatal care attendance among pregnant women in Ghana. Methods: A cross-sectional research design was employed in the study. Ghana Living Standard Survey Round 6 (2013) data was utilized. Data was analyzed using STATA 15 statistical package. Propensity score matching procedure was used to estimate the impact of NHIS enrolment on antenatal care attendance. Results: The proportion of pregnant women with valid NHIS card was found to be 40.63%. The study found age and some regions (Central, Volta, Eastern, Upper East and Upper West) of Ghana to be significant predictors of NHIS enrolment. Factors identified to have significant effects on antenatal care attendance were NHIS membership, age, parity, income, secondary education, religion(Islam), marital status (censual union), ethnicity (Gurma, MoleDagbani, Grusi, others). The propensity score matching procedure estimated a 4.2 percentage point increase in antenatal care attendance by national health insurance scheme enrolment. Conclusion: Insured pregnant women utilized antenatal care more than the uninsured pregnant women. National health insurance was found to have increased antenatal care attendance by 4.2 percentage point. These findings highlight the need for the National Health x Insurance Authority to strengthen the exemptions policy under the National Health Ins