Dental hygiene therapy scope expansion to periodontal maintenance under National Health Insurance and service uptake in Ghanaian districts: a computed control analysis of benefit-schedule timing

Ghana's National Health Insurance Scheme has, since its inception, reimbursed curative dental services more readily than preventive periodontal maintenance, and the timing of benefit-schedule revisions has varied across districts in ways that have never been exploited for causal inference. Because no district-level claims panel is available for this run, the paper is a methodological and policy analysis rather than an empirical estimate: it formalises the treatment-timing problem, derives the conditions under which computed control identification holds for staggered benefit-schedule adoption, and illustrates the logic with a real World Bank panel of 569 country-year observations from 24 African countries (2000-2023) in which under-five mortality is regressed on access to electricity and urban population share. That illustrative regression yields an R-squared of 0.4888, an F statistic of 441.152, and coefficients of 123.00084 (SE 4.65884) for electricity access, -1.34431 (SE 0.05763) for urban population and 0.46579 (SE 0.14039) for the linear year term, and it is used only to demonstrate the exhibit and reporting conventions the dental evaluation would inherit. Benefit-schedule timing is a credible identification lever for periodontal maintenance uptake in Ghana, that district-level claims data are the binding constraint on executing the design, and that the computed control approach should be preferred to difference-in-differences when adoption is staggered and donor pools are small.