Internal migration versus social protection on catastrophic health payments by poor households in Northern Ghana

• In Event: Migration & Population Issues in International Contexts

Abstract

Background: Catastrophic health expenditures (CHE) remain a major source of financial vulnerability for households in many low- and middle-income countries, particularly where reliance on out-of-pocket health payments is high and formal risk protection mechanisms are limited. In such contexts, households often adopt coping strategies, including labour migration, to manage economic and health-related shocks. However, the extent to which migration enhances financial protection against health expenditures among left-behind household members remains insufficiently understood. Purpose: This study examines whether household migration improves financial protection against catastrophic health expenditures among poor households in Northern Ghana. Data: The analysis draws on quantitative panel data from three survey waves (2015, 2017, and 2022) covering households associated with the Livelihood Empowerment Against Poverty (LEAP) programme. Methods: We employ correlated random effects models to estimate the effects of migration on the probability of experiencing CHE across five thresholds. To capture different dimensions of financial burden, CHE is measured using both the household health payment budget share and the capacity-to-pay definitions. Results: The results show that labour migration significantly reduces the likelihood of catastrophic health expenditures across multiple thresholds, with effects that are stronger and more consistent under the capacity-to-pay measure. These findings suggest that migration plays a particularly important role in protecting households once basic consumption needs are taken into account. In contrast, non-labour migration does not exhibit a statistically robust association with CHE. Participation in the LEAP social protection programme is associated with modest reductions in financial vulnerability; however, these effects are generally smaller and less consistent than those associated with labour migration. Conclusion: Overall, the findings indicate that while migration enhances household financial resilience to health shocks through income diversification and remittance flows, reliance on migration alone is insufficient to ensure sustained financial protection. Strengthening health financing systems, expanding effective insurance coverage, and integrating social protection with healthcare provision are therefore essential for reducing catastrophic health expenditures and improving equitable access to care in migrant-sending regions.

Author

• Christian Kwaku Osei, University of North Carolina at Chapel Hill
  Presenting Author