District Hospital Trauma Survivor Mental Health Screening Reimbursement Denial Thresholds and Follow-Up Completion in Ghanaian Clinics: A Regression Discontinuity Analysis of Claims Audit Rules

Ghana's National Health Insurance Scheme reimburses district hospital trauma care through claims audits that deny payment when documented mental health screening falls below an audit threshold. Whether that threshold changes clinician behaviour and, in turn, survivor follow-up completion is unknown, and the audit rule has never been evaluated as a threshold exposure. The design specifies the running variable, the cutoff, the bandwidth, the local linear estimator and the manipulation and covariate-balance checks required before a causal interpretation is defensible. The protocol also specifies a difference-in-discontinuities extension that exploits staggered threshold revisions across audit regions. No empirical estimates are reported; the contribution is a pre-specified, falsifiable design that converts an administrative reimbursement rule into an identifiable exposure. The protocol is intended to let future evaluations distinguish whether denial thresholds suppress screening documentation, redirect clinician effort toward billable activities, or leave follow-up completion unchanged, and to make those distinctions before rather than after the data are analysed.