IMPACT OF SOCIAL HEALTH INSURANCE ON HOUSEHOLD SAVINGS AND INVESTMENT DECISIONS IN SIERRA LEONE

Abstract

Out-of-pocket healthcare expenditure remains a major source of household financial vulnerability in Sierra Leone. Although social health insurance (SHI) is primarily designed to improve access to healthcare and financial protection, its potential influence may extend beyond health service utilisation to household savings and productive investment decisions.

**Objective:** This article evaluates the expected impact of SHI on household savings and investment behaviour in Sierra Leone.

**Methods:** The article draws on the Objective Four components of a cross-sectional doctoral study conducted among household heads or adult household financial decision-makers in selected districts of Sierra Leone. Quantitative survey data were analysed using descriptive statistics and multiple regression models. The savings and investment models estimated the relationship between willingness to enrol, willingness to pay, household income, out-of-pocket healthcare expenditure, household size, and household savings and investment outcomes. Qualitative focus group discussion findings were used to enrich interpretation of the quantitative results.

**Results:** Willingness to enrol in SHI was positively and significantly associated with household savings (coefficient = 0.281; p = 0.007) and household investment (coefficient = 0.298; p = 0.008). Willingness to pay was also positively associated with savings (coefficient = 0.169; p = 0.010) and investment (coefficient = 0.172; p = 0.012). Household income produced the strongest positive effect in both models, while out-of-pocket healthcare expenditure and household size had negative and statistically significant effects. The savings model explained 41% of the variation in household savings, while the investment model explained 44% of the variation in household investment.