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This paper seeks to answer a simple question; what happens to maternal health seeking-behavior when user-fees are eliminated? We analyze this question empirically by investigating the effects of the free maternal health care (Health Insurance) policy instituted by the government of Ghana, on a variety of health utilization measures and child survival outcomes. Using robust linear and binomial logistic estimation techniques, we find evidence from over 4,000 households, that eliminating user-fees significantly increases the utilization of skilled delivery assistance whilst simultaneously reducing the number of deliveries assisted by unskilled birth attendants. Utilization of antenatal and postnatal care experience similar effects with user-fee elimination. Even though intention to use contraceptives increases with enrollment in the programme, education is found to be more important than health insurance in influencing the number of children a woman desires to have. This paper provides empirical support for the growing calls for removal of user-fees, in order to expand healthcare access and promote inclusion.


This paper was the 2017 winner of the King-Mertz Research/Creative Activity Award

King-Mertz Research/Creative Activity Awards

Description: This award recognizes the highest achievement in graduate research based on non-thesis graduate research/creative activity projects required for a degree program and completed between Jan. 1 and Dec 31 the prior year. Graduate degree-seeking candidates who completed the research/creative activity as part of the requirements for the graduate degree during the dates specified are eligible. Each degree program selects one project to forward to The Graduate School's College Screening Committee. Program nominations are reviewed and selected according to procedures developed by the degree program.

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