Linking occupational risk exposure to individual out-of-pocket health expenditure in Ghana

Occupational risk exposure (ORE) is a major but underexplored driver of health need in Ghana’s labour market, where informal and hazardous employment is widespread. While theory predicts that elevated health need from ORE should increase healthcare spending, limited access to care may prevent this need from translating into commensurate spending. This study examines the effect of ORE on out-of-pocket (OOP) health expenditure in Ghana. Using nationally representative panel data from the 2022 Annual Household Income and Expenditure Survey (AHIES), we estimate a two-part model to distinctly analyse the likelihood of incurring health expenditure and the level of spending conditional on seeking care. ORE is measured using multidimensional indices constructed via Multiple Correspondence Analysis (MCA). To address endogeneity, we employ a control function approach using sectoral risk exposure as an instrument. We further conduct dimensional analysis and counterfactual margins analysis to assess heterogeneity and the moderating role of occupational safety and health (OSH) measures. ORE significantly increases the probability of incurring health spending but lowers conditional spending among those who seek care. Thus, a one standard deviation increase in occupational risk exposure raises the probability of incurring health expenditure by 21.4 percent but reduces conditional spending among care-seekers by 15.6 percent, indicative of constrained healthcare utilisation. This is suggestive that while occupational hazards raise healthcare needs, financial constraints limit the intensity of care received. All ORE dimensions namely, air pollution, chemical, and injury risks independently increase healthcare utilization. OSH measures significantly lower the probability of health expenditure and mitigate the effect of ORE, with safety orientation and personal protective equipment showing the strongest effects. OOP health expenditure underestimates the true health burden of occupational risk exposure in Ghana. Strengthening workplace safety and financial protection mechanisms is critical to improving both health outcomes and healthcare access.