MULTIVARIATE BIOSTATISTICAL ANALYSIS OF HEALTH INSURANCE COVERAGE AND ACCESS TO HEALTHCARE SERVICES IN GHANA USING COMPLEX SURVEY DATA

Access to healthcare is a fundamental human right, yet in Ghana, disparities persist due to uneven health insurance coverage and socioeconomic inequities. This study is crucial as it addresses a significant policy gap by analyzing how demographic and structural factors influence healthcare access, using robust multivariate biostatistical tools on complex survey data from 2020-2024. The primary objective was to examine how health insurance type, income, education, employment, gender, and location affect access to healthcare services. Employing Generalized Linear Mixed Models, chi-square tests, ANOVA, and correlation analyses on a nationally representative sample of 3,000 respondents, the study found that public insurance covered 40.0% of the population, while 33.3% remained uninsured. The chi-square test revealed a significant association between insurance type and healthcare utilization (χ² = 198.42, p< 0.001), with private insurance holders accessing care more frequently. ANOVA results confirmed that income significantly affects insurance status (F = 87.19, p< 0.001), and education showed a positive gradient with healthcare access-from 55% (primary) to 85% (tertiary). Urban residents accessed healthcare at a rate of 78.0% compared to 49.0% for rural residents (t = 19.42, p< 0.001), and females utilized services more than males (t = 6.37, p< 0.01). The correlation matrix showed strong associations between insurance and education (r = 0.50), income (r = 0.45), and healthcare visits (r = 0.40). The overall regression model explained 61% of the variance in healthcare access (R² = 0.61), identifying education (β = 0.34), insurance (β = 0.29), and income (β = 0.27) as the strongest predictors. These findings imply that achieving equitable healthcare requires integrated policies that combine economic support, education, and infrastructure, particularly for rural and low-income populations. It is recommended that Ghana adopt targeted subsidies, mobile clinics, and gender-sensitive outreach programs to bridge the coverage and access gaps.