Panel Paper: Supply Versus Demand Side Interventions to Boost Health Outcomes: Evidence From Ghana's LEAP Program

Thursday, November 8, 2012 : 3:20 PM
Hanover B (Radisson Plaza Lord Baltimore Hotel)

*Names in bold indicate Presenter

Sudhanshu Handa, University of North Carolina, Chapel Hill and Michael Park, University of North Carolina

Social cash transfers (SCT) are rapidly gaining popularity in developing countries as a way to mitigate poverty and break the inter-generational cycle of poverty by allowing families to invest in the human capital of their children.  The Government of Ghana recently initiated the Livelihood Empowerment against Poverty Program (LEAP), a SCT that is the flagship program in the nation’s Social Protection Strategy. LEAP targets ultra-poor households with orphans and vulnerable children, elderly and disabled, and provides GHS8-15 per month depending on household size. A unique feature of LEAP is its strategy to leverage Ghana’s recently initiated National Health Insurance Scheme (NHIS). LEAP households automatically qualify for subsidized enrollment into the NHIS and participation in the NHIS is a condition for remaining in LEAP.

The overarching evaluation question of this study is to assess the impact of ‘cash plus health insurance’ versus ‘health insurance only’ on the health and human capital investment behavior of poor households. To address this question, the study will compare outcomes among LEAP households who have received cash and subsidized health insurance with two non-LEAP comparison groups, one that has health insurance and one that does not. The hypothesis of this study is that the comprehensive treatment (insurance plus cash) will have the largest impact because of the substitution and income effects induced by the treatment, but the extent of the difference in impacts will depend on the magnitude of out-of-pocket direct costs required to access health and education services.  This study focuses on both health inputs and outcomes in order to fully understand the causal pathway through which the treatment operates. 

The research design entails a longitudinal propensity score matching (PSM) design. Baseline data have been collected from future beneficiaries who are part of a larger nationally representative sample of households surveyed as part of a research study conducted by the Institute of Statistical, Social and Economic Research (ISSER) of the University of Ghana. A comparison group of ‘matched’ households have been selected from the ISSER sample and will be re-interviewed after 24 months along with LEAP beneficiaries to measure changes in outcomes across treatment and comparison group.  The core evaluation strategy will thus employ a difference-in-differences (DD) propensity score matching (PSM) estimator to measure the impact of LEAP. Preliminary results show that LEAP has the potential to impact several key human development indicators including girls’ secondary school enrolment, curative health care, school attendance, and household diet diversity.  

Since coverage of the LEAP and NHIS programs is still in the early phase, a unique and exciting opportunity exists to evaluate the two programs and see whether the ‘cash plus health insurance’ approach of LEAP provides additional impacts over health insurance alone versus no treatment. This study will serve to provide causal evidence on the impact of health insurance on health inputs and outcomes in a developing country.