Internal Migration and Access to Health Insurance in Ghana: A Gendered Perspective.

Abstract

Universal health coverage is a core strategy for attaining Sustainable Development Goal 3 of ensuring healthy lives and promoting wellbeing. Migration, like gender, is a social determinant of health and access to health insurance. Complementing recent studies on equitable access to health care, this paper examines the relationship between internal migration and access to health insurance in Ghana using a gendered lens. This study utilises data on 35302 persons (16685 men and 18617 women) aged 15 years and above from the Ghana Living Standards Survey Round 7. Using gender-stratified logit models, we assess the effects of migrant status on current health insurance enrolment adjusting for other background factors. Overall, about 56% of people are enrolled on health insurance, with higher enrolment among women (60%) than men (43%). Urban non-migrants and urban in-migrants have the highest proportions enrolled while rural in-migrants have the lowest. Apart from urban nonmigrants, rural-urban migrants have a higher proportion enrolled than all other categories. Among women, rural-urban migrants are less likely than urban non-migrants to be enrolled but among men only this applies to urban-rural migrants. Rural-rural migrants are the least likely to be enrolled, compared with urban non-migrants among all groups. Internal migration is significantly associated with access to health; however, the patterns of association are different for men and women in Ghana. The findings highlight the unequal access by in-migrants to healthcare. Efforts to improve universal access to health care must strategically target migrants, using a gendered approach, to increase their health insurance coverage in Ghana.