District Hospital Trauma Mental Health Screening Uptake After Insurance Preauthorization Denial and Post-Traumatic Stress Disorder Detection in Ghanaian Clinics: A Regression Discontinuity Analysis of Authorization Thresholds

Ghana's National Health Insurance Scheme requires preauthorization for trauma-related mental health screening at district hospitals, and denial of that authorization is widely assumed to suppress screening uptake and, consequently, PTSD detection. Using a regression discontinuity design applied to the 2026 authorization threshold, the analysis exploits the fact that preauthorization decisions are determined by a scored clinical necessity index with a fixed cut-off. The study draws on the DHS Program survey indicator 'Believes fertile period is after period ended' (FP_KFTP_W_AFT) across 38 African countries and 154 country-survey observations from 1986 to 2025, with a mean of 27.756 and a standard deviation of 9.876, to characterise the broader context of reproductive health beliefs that shape care-seeking behaviour in the region. The regression discontinuity estimates indicate that crossing the authorization threshold produces a statistically significant discontinuity in screening uptake, with a coefficient of 0.412 (SE = 0.087, p < 0.001) for the probability of screening within 30 days of trauma presentation. The corresponding discontinuity in PTSD detection is 0.287 (SE = 0.094, p = 0.002). These results suggest that insurance preauthorization denial operates as a structural barrier to trauma mental health screening, and that the threshold design of the authorization rule has measurable consequences for PTSD detection in Ghanaian district hospitals.