Abstract
BACKGROUND: This study examined the spatial distribution and factors associated with health insurance subscription among women in Ghana. METHODS: We analysed a representative sample of 9380 women aged 15-49 y from the 2014 Ghana Demographic and Health Survey. Descriptive and multilevel regression analyses were performed. The study also employed spatial analysis techniques, including spatial autocorrelation, hotspot analysis, cluster and outlier analysis, as well as geographically weighted regression to explore the geographic distribution and predictors of non-subscription to health insurance. RESULTS: The analysis revealed a moderately high prevalence of health insurance subscription among women in Ghana (62.4%). The spatial analyses indicated substantial variations in health insurance subscription across different regions in Ghana. The coastal and middle zones reported higher rates of non-subscription compared with the northern zone. We observed that young women (aged 20-24 y) had a lower likelihood of subscribing compared with adolescent girls (aged 15-19 y). Also, higher educational attainment, listening to the radio, being in a marital union and higher wealth status were positively associated with health insurance subscription. CONCLUSIONS: The study calls for targeted interventions and policies to promote equitable access to healthcare services, focusing on improving health infrastructure in coastal and middle zones, educational campaigns for individuals with lower education levels, leveraging media platforms for health insurance awareness and implementing equitable and affordable processes for individuals in poorer households.