In 2003 the Government of Ghana established a National Health Insurance Scheme (NHIS), to make health care more affordable for Ghanaians; it is envisaged that the NHIS will eventually replace the existing cash-and-carry system. Sponsored by the Bill and Melinda Gates Foundation and the Global Development Network (GDN), this study evaluates the NHIS to determine whether it is fulfilling the needs for which it was established. We accomplish this task by focusing on the health status of women to see whether the NHIS has yielded any positive health outcomes regarding maternal and child health in Ghana. With this approach, we are able to situate our evaluation in the context of the Health MDGs, two of which (#4 and #5) deal specifically with the health of women and children. We rely primarily on Propensity Score Matching to undertake our evaluation. With this we are able to match relevant background characteristics of women who are enrolled in the NHIS with those of non-members and compare their health outcomes. Our findings suggest that the NHIS has yielded some verifiable positive outcomes: Women who are enrolled are more likely to give birth in hospitals, to have their births attended by trained health professionals, to receive prenatal care; to have fewer birth complications, and to experience fewer infant deaths