IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v31y2022i10p2120-2141.html
   My bibliography  Save this article

The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment

Author

Listed:
  • Stephen Kwasi Opoku Duku
  • Edward Nketiah‐Amponsah
  • Christine J. Fenenga
  • Wendy Janssens
  • Menno Pradhan

Abstract

Health insurance enrollment in many Sub‐Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical‐technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured.

Suggested Citation

  • Stephen Kwasi Opoku Duku & Edward Nketiah‐Amponsah & Christine J. Fenenga & Wendy Janssens & Menno Pradhan, 2022. "The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment," Health Economics, John Wiley & Sons, Ltd., vol. 31(10), pages 2120-2141, October.
    • Handle: RePEc:wly:hlthec:v:31:y:2022:i:10:p:2120-2141
    DOI: 10.1002/hec.4556
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.4556
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.4556?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Joseph J. Capuno & Aleli D. Kraft & Stella Quimbo & Carlos R. Tan & Adam Wagstaff, 2016. "Effects of Price, Information, and Transactions Cost Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme: A Randomized Experiment in the Philippines," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 650-662, June.
    2. Abhijit Banerjee & Amy Finkelstein & Rema Hanna & Benjamin A. Olken & Arianna Ornaghi & Sudarno Sumarto, 2019. "The Challenges of Universal Health Insurance in Developing Countries: Evidence from a Large-scale Randomized Experiment in Indonesia," NBER Working Papers 26204, National Bureau of Economic Research, Inc.
    3. Devadasan, Narayanan & Ranson, Kent & Van Damme, Wim & Acharya, Akash & Criel, Bart, 2006. "The landscape of community health insurance in India: An overview based on 10 case studies," Health Policy, Elsevier, vol. 78(2-3), pages 224-234, October.
    4. Martina Björkman & Jakob Svensson, 2009. "Power to the People: Evidence from a Randomized Field Experiment on Community-Based Monitoring in Uganda," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 735-769.
    5. Adam Wagstaff & Ha Thi Hong Nguyen & Huyen Dao & Sarah Bales, 2016. "Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 663-674, June.
    6. Robert Kaba Alhassan & Stephen Opoku Duku & Wendy Janssens & Edward Nketiah-Amponsah & Nicole Spieker & Paul van Ostenberg & Daniel Kojo Arhinful & Menno Pradhan & Tobias F Rinke de Wit, 2015. "Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-19, October.
    7. Robert Kaba Alhassan & Edward Nketiah-Amponsah & Daniel Kojo Arhinful, 2016. "Design and implementation of community engagement interventions towards healthcare quality improvement in Ghana: a methodological approach," Health Economics Review, Springer, vol. 6(1), pages 1-13, December.
    8. Stephen Kwasi Opoku Duku & Edward Nketiah-Amponsah & Wendy Janssens & Menno Pradhan, 2018. "Perceptions of healthcare quality in Ghana: Does health insurance status matter?," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-17, January.
    9. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    10. Sauerborn, R. & Nougtara, A. & Hien, M. & Diesfeld, H. J., 1996. "Seasonal variations of household costs of illness in Burkina Faso," Social Science & Medicine, Elsevier, vol. 43(3), pages 281-290, August.
    11. Achyuta Adhvaryu & Anant Nyshadham, 2015. "Return to Treatment in the Formal Health Care Sector: Evidence from Tanzania," American Economic Journal: Economic Policy, American Economic Association, vol. 7(3), pages 29-57, August.
    12. Abhijit Banerjee & Amy Finkelstein & Rema Hanna & Benjamin A. Olken & Arianna Ornaghi & Sudarno Sumarto, 2021. "The Challenges of Universal Health Insurance in Developing Countries: Experimental Evidence from Indonesia's National Health Insurance," American Economic Review, American Economic Association, vol. 111(9), pages 3035-3063, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Stephen K.O. Duku & Edward Nketiah-Amponsahd & Christine J. Fenenga & Daniel K. Arhinful & Wendy (W.) Janssens & Menno (M.) Pradhan, 2018. "The Effect of Community Engagement on Healthcare Utilization and Health Insurance Enrolment in Ghana Results from a Randomized Experiment," Tinbergen Institute Discussion Papers 18-017/V, Tinbergen Institute.
    2. Baillon, Aurélien & Capuno, Joseph & O'Donnell, Owen & Tan, Carlos Antonio & van Wilgenburg, Kim, 2022. "Persistent effects of temporary incentives: Evidence from a nationwide health insurance experiment," Journal of Health Economics, Elsevier, vol. 81(C).
    3. Robyn, Paul Jacob & Bärnighausen, Till & Souares, Aurélia & Traoré, Adama & Bicaba, Brice & Sié, Ali & Sauerborn, Rainer, 2014. "Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study," Social Science & Medicine, Elsevier, vol. 108(C), pages 223-236.
    4. Dupas, Pascaline & Jain, Radhika, 2023. "Can beneficiary information improve hospital accountability? Experimental evidence from a public health insurance scheme in India," Journal of Public Economics, Elsevier, vol. 220(C).
    5. Igor Francetic & Günther Fink & Fabrizio Tediosi, 2021. "Impact of social accountability monitoring on health facility performance: Evidence from Tanzania," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 766-785, April.
    6. Patrick Opoku Asuming & Hyuncheol Bryant Kim & Armand Sim, 2021. "Selection and Behavioral Responses of Health Insurance Subsidies in the Long Run: Evidence from a Field Experiment in Ghana," Papers 2105.00617, arXiv.org.
    7. Abhijit Banerjee & Amy Finkelstein & Rema Hanna & Benjamin A. Olken & Arianna Ornaghi & Sudarno Sumarto, 2019. "The Challenges of Universal Health Insurance in Developing Countries: Evidence from a Large-scale Randomized Experiment in Indonesia," NBER Working Papers 26204, National Bureau of Economic Research, Inc.
    8. Michael Hillebrecht & Stefan Klonner & Rainer Sauerborn & Alie Sié & Aurélia Souares, 2021. "The Demand for Health Insurance in a Poor Economy: Evidence from Burkina Faso," Economic Development and Cultural Change, University of Chicago Press, vol. 69(4), pages 1273-1300.
    9. Aurélien Baillon & Aleli Kraft & Owen O’Donnell & Kim Wilgenburg, 2022. "A behavioral decomposition of willingness to pay for health insurance," Journal of Risk and Uncertainty, Springer, vol. 64(1), pages 43-87, February.
    10. Banerjee, Abhijit & Finkelstein, Amy & Hanna, Rema & Olken, Benjamin & Ornaghi, Arianna & Sumarto, Sudarno, 2020. "Subsidies and the Dynamics of Selection:Experimental Evidence from Indonesia's National Health Insurance," CAGE Online Working Paper Series 454, Competitive Advantage in the Global Economy (CAGE).
    11. Owen O'Donnell & Andrew M. Jones, 2016. "Symposium: Efforts to Extend Effective Coverage in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 647-649, June.
    12. Giles, John & Meng, Xin & Xue, Sen & Zhao, Guochang, 2021. "Can information influence the social insurance participation decision of China's rural migrants?," Journal of Development Economics, Elsevier, vol. 150(C).
    13. Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.
    14. Patrick Asuming & Hyuncheol Bryant Kim & Armand Sim, 2018. "Long-run Consequences of Health Insurance Promotion When Mandates are Not Enforceable: Evidence from a Field Experiment in Ghana," Papers 1811.09004, arXiv.org, revised Jun 2019.
    15. Asuming, Patrick Opoku & Kim, Hyuncheol Bryant & Sim, Armand, 2017. "Long-Run Consequences of Health Insurance Promotion: Evidence from a Field Experiment in Ghana," IZA Discussion Papers 11117, Institute of Labor Economics (IZA).
    16. Tahir Andrabi & Jishnu Das & Asim Ijaz Khwaja, 2017. "Report Cards: The Impact of Providing School and Child Test Scores on Educational Markets," American Economic Review, American Economic Association, vol. 107(6), pages 1535-1563, June.
    17. Stephan Litschig, 2008. "Financing local development: Quasi-experimental evidence from municipalities in Brazil, 1980-1991," Economics Working Papers 1142, Department of Economics and Business, Universitat Pompeu Fabra, revised Jun 2012.
    18. B Kelsey Jack, "undated". "Market Inefficiencies and the Adoption of Agricultural Technologies in Developing Countries," CID Working Papers 50, Center for International Development at Harvard University.
    19. Raza, W.A. & Panda, P. & Van de Poel, E. & Dror, D.M. & Bedi, A.S., 2013. "Healthcare Seeking Behavior among Self-help Group Households in Rural Bihar and Uttar Pradesh, India," ISS Working Papers - General Series 50172, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    20. Margaret Triyana, 2016. "Do Health Care Providers Respond to Demand-Side Incentives? Evidence from Indonesia," American Economic Journal: Economic Policy, American Economic Association, vol. 8(4), pages 255-288, November.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:31:y:2022:i:10:p:2120-2141. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.