Joint modelling of health insurance, healthcare utilisation, healthcare expenditure and health status: Evidence from Ghana

Abstract

Abstract: The purpose of this paper is to examine the determinants of health insurance, healthcare utilisation, healthcare expenditure, and health status simultaneously. The study used secondary data from the Ghana Socioeconomic Panel Survey. Health insurance, healthcare utilisation, healthcare expenditure, and health status were estimated simultaneously using the conditional mixed process (CMP) framework. The CMP corrects for likely heterogeneity and sample selection bias. The results revealed a significant association between insurance, healthcare utilisation, healthcare expenditure, and health status, implying that regressing these models apart would yield bias and inconsistent estimates making CMP estimates superior to single estimations. The results discovered that gender, age, education, obesity, physical activity, wealth index, household size, dependency ratio, formal-sector work, and savings significantly drive NHIS enrolment. Gender, age, education, obesity, chronic illness, physical activity, wealth index, risky behaviour, and type of illness influenced individuals’ visits to a health facility. The determinants of out-of-pocket payments were gender, chronic illness, wealth index, risky behaviour, distance to a health facility, and fever and diarrhoea sufferers. Finally, drivers of self-assessed health were gender, age, education, chronic illness, physical activity, wealth index, risky behaviour, fever, cold/cough and diarrhoea.

Keywords

• conditional mixed process
• healthcare utilisation
• healthcare expenditure
• health insurance
• health status