Résumé : This paper uses a propensity score matching approach to assess the impact of Ghana’s National Health Insurance Scheme (NHIS) on health utilization and health outcomes for children under five years old using a nationally representative Multiple Indicator Cluster Survey from 2011. The results show that even though health insurance is free for children, around half of them are not insured, with the probability of enrollment being significantly affected by many characteristics. Nationally, the insurance increases both health care utilization and the overall health status of children. Nevertheless, there are important discrepancies across regional results suggesting that the largest gains are found in the poorest regions, which correspond to those with the worse average health outcomes. However, some other regions present none or only very limited gains attributable to the insurance.