How Effective Is The NHIS?

The National Health Insurance Scheme is a form of National health insurance established by the Government of Ghana, with a goal to provide equitable access and financial coverage for basic health care services to Ghanaian citizens.

The idea for the National Health Insurance Scheme (NHIS) in Ghana was conceived by former President John Kuffuor who when seeking the mandate of the people in the 2000 elections, promised to abolish the cash and carry system of health delivery. Under the cash and carry system, the health need of an individual was only attended to after initial payment for the service was made. Even in cases when patients had been brought into the hospital on emergencies it was required that money was paid at every point of service delivery.

Upon becoming president, former President Kuffuor pushed through his idea of getting rid of “cash and carry” and replacing it with an equitable insurance scheme that ensured that treatment was provided first before payment for Ghanaian citizens. In 2003, the scheme was passed into law. Under the law, there was the establishment of Ghana National Health Insurance Authority which licenses, monitors and regulates the operation of health insurance schemes in Ghana. Like many countries in the world, Ghana's health insurance was fashioned out to meet specific needs of Ghanaian citizens.

The National Health Insurance Scheme is a form of National health insurance established by the Government of Ghana. The scheme provides equitable access and financial coverage for basic health care services to the Ghanaian population. The objective of the NHIS is to secure the implementation of the national health insurance policy that ensures access to basic healthcare services to all residents of Ghana.

The health insurance was set up to allow Ghanaian citizens to make contributions into a fund so that in the event of illness Ghanaian contributors could be supported by the fund to receive affordable health care. Under this policy, three types of health insurance schemes were set up. They were:

The District-Wide Mutual Health Insurance Scheme.
The Private Mutual Health Insurance Scheme.
The Private Commercial Health Insurance Scheme.
In order for the system to function well, the government decided to support the District Mutual Health Insurance Scheme concept to ensure that:

Opportunity is provided for all Ghanaian citizens to have equal access to the functional structures of health insurance. A sustainable Health Insurance option is made available to all Ghanaian citizens. The quality of health care provision is not compromised under Health Insurance.

FINANCING
Five main sources of funds accrue to a National Health Insurance Fund (NHIF) used primarily to finance services provided and cover administrative costs of the NHIC:

• appropriation of 2.5% of all funds mobilized from workers’ pension contributions to the SSNIT

• an ad valorem tax of 2.5% levied specifically for health insurance on all goods and services purchased or provided on which value added tax is charged

• government annual budgetary allocations proposed and approved by parliament to the NHIF

• accruals from investments of surplus funds held in the NHIF by the NHIC

• gifts and donations made by individuals or organizations to the NHIF

CHALLENGES FOR HEALTH SYSTEM FINANCING AND THE WAY FOWARD

CHALLENGES

1. Low tax or revenue based for raising domestic funds. Low priority given to health in public sector resource allocation.
2. Limited evidence for priority setting and limited capacity to generate and use evidence at all levels of the system but particularly at sub-national levels
3. Insufficient, volatile external funds .Bilateral funding often exacerbate cyclical downturns; there can be sudden large increases for selected activities and sudden decreases for a variety of reasons
4. Financial barriers to care (out-of-pocket-payment and transport) related to distance and user charges and the associated financial catastrophes experienced by some households that pay for care
5. Inequalities in service utilization and health outcomes with public expenditure frequently benefiting the rich than the poor and other disadvantaged groups
6. Provide incentives that demotivates staff (public) or encourage inefficient or even harmful behaviors (public and private)
7. Limited accountability and transparency in financing systems, contributing to the prevalence of informal payment and creating scope for resource mismanagement.
8. Identify set of basic financial informational requirements and inexpensive and timely methods of obtaining reliable information
9. Weak costing, budgeting, financial management, expenditure tracking and auditing systems and weak capacity to use them at all levels of government.

WAY FOWARD

1. Increase collection of taxes or contributions to health insurance. This does not have to be through increased rate but could be through more efficient collection.
2. Make better use of new and existing resources including reducing inefficiency
3. Donors and lending institutions agree to mechanisms to ensure stable, increased flows for health.
4. Strengthens government financial planning, budgeting and monitoring processes so that funding gaps can be identified early and addressed.
5. Promote increased pre-payment for health care so as to reduce financial barriers at point of use.
6. Reduce or remove user fees or co-payment (this will increase use but reduce available funds if new resources are not found).
7. Provide services according to needs.
8. Create incentives (including financial incentives) for providers to address the needs of the poor (example bonus payments for increasing immunization rates in remote areas)
9. Promote performance based payment systems.
10. Strengthen links between financial data, activity data and outcome data
11. Communications or outreach programmes to increase population awareness of their entitlement.