Income and health insurance effects on modern health-seeking behaviours in rural Ghana: nature and extent of bias involved

Purpose This study examined the influence of income and health insurance on the health-seeking behaviour of rural residents, addressing the concerns of endogeneity and heterogeneity bias.Design/methodology/approach A two-stage residual inclusion was utilised to correct self-selection-based endogeneity problems arising from health insurance membership.Findings This study provides support for Andersen's behavioural model (ABM). Income and health insurance positively stimulate rural residents' use of modern healthcare services, but the effect of insurance risks a downward bias if treated as exogenous. Further, the effect of health insurance differs between males and females and between adults and the elderly.Originality/value This study advances the literature, arguing that, within the ABM framework, enabling (i.e. income and insurance) and predisposing factors (i.e. age and gender) complement each other in explaining rural residents' use of modern health services.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-03-2023-0223