Crowding out of solidarity? Public health insurance versus informal transfer networks in Ghana

This paper delivers empirical evidence on how transfers that serve as an informal insurance mechanism are affected by a formal and country-wide health insurance scheme. Using the fifth and fourth waves of the Ghanaian Living Standard Household Survey, we investigate the extent to which the implementation of the National Health Insurance Scheme affects health-related outcomes and making or receiving informal transfers. Our findings suggest that there is a reduction of out-of-pocket expenditures for health services and a significant crowding out of informal transfers. We conclude that the provision of formal health insurance does not only relieve ill individuals from out-of-pocket expenditures, but also their network partners from making informal transfers.