Determinants and the impact of the National Health Insurance on neonatal mortality in Ghana.

The national health insurance was established to increase access to health care services and the maternal component was later introduced to improve the health outcomes of both mother and child. The main objectives of this study are to investigate the factors that affect neonatal deaths as well as examine the effect of the Ghana Health Insurance on neonatal deaths in Ghana. Using the most recent round of the Ghana Demographic and Health Survey, the study estimates the probit model with interaction effects to account for the heterogeneity in outcomes. Additionally, the study employs the propensity score matching approach to account for the possible endogeneity in the insurance enrolment decision. Results from the estimations, after controlling for relevant individual and household characteristics suggest that the national health insurance significantly reduces the likelihood of neonatal deaths. Estimates remain consistent even after more robust estimators are employed. Estimates from the interaction between place of residence and health insurance indicate that health insurance beneficiaries who reside in urban areas are at a higher risk of neonatal deaths compared to other women. Access to medical facilities proxied by distance to the nearest health post emerged as an important predictor of neonatal death. The study also suggests significant regional differences in neonatal deaths. We, therefore, conclude that the national health insurance may have the potential to substantially improve the health outcomes of neonates and have policy implications for increasing coverage to more mothers and their neonates, as well as coverage in critical neonatal services and drugs.