Ghana’s National Health Insurance Scheme (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 Kufuor 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 Kufuor 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 NHIC 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.

Premiums
Like all insurance schemes, different types of premiums are available under the country's NHIS. Ghanaian contributors are grouped according to their levels of income. Based on the group a Ghanaian contributor may fall in, there is specific premium that ought to be paid. This was done since the socio-economic condition scheme contributors is not the same and the Ghanaian contributions was to be affordable for all to ensure that nobody is forced to remain in cash and carry system. This meant that Ghanaian contributions payable could vary from one district to the other as even the disease burden was also not the same in all the districts. To ensure that all Ghanaian citizens made some contribution to the scheme, a 2.5% Health Insurance Levy on selected goods and services was passed into law so that the money collected could be put into a National Health Insurance Fund to subsidize fully paid contributions to the District Health Insurance Schemes.

FEATURES OF THE NHIS
LEGISLATIVE INSTRUMENT
Act 650 (2003) and LI 1809 (2004) are the main legal frameworks guiding the implementation of health insurance in Ghana.

GOVERNANCE
A 15-member National Health Insurance Council (NHIC) was established to manage the National Health Insurance Fund, provide subsidies to district-wide mutual health insurance schemes, regulate the insurance market, and license and monitor service providers under the scheme.

ADMINISTRATION
A national Health Insurance Secretariat provides administrative support to the NHIC in implementation of the scheme. District mutual health insurance schemes (DMHIS), established by sponsors identified by the district assemblies or by the NHIC as corporate bodies, implement the scheme at the district level. Private sector schemes may be established but do not receive government subsidies. They operate as insurance schemes based on a premium, contract, and policy. A Health Complaints Committee was established in every district office of the NHIC.

MEMBERSHIP
Enrollment and membership in a DMHIS is mandatory for all residents of Ghana except people in the Ghana Armed Forces or the Ghana Police Service or people who have proof of holding a health insurance policy. People eligible for membership are expected to pay a contribution of GHC 7.20 a year (equivalent to US$7.74 when the act was passed). A period of six months may lapse between payment of membership and issuance of membership cards, which provide access to service. Exemptions from payment are provided to the following groups:

• Contributors to the national Social Security and National Insurance Trust (SSNIT) or people drawing pension benefits from the SSNIT.

• People under the age of 18 with at least one parent paying membership fees or covered by the exemption clause.

• People above the age of 70.
• People classified as indigent according to the criteria set by Act 650 and LI 1809.

SERVICE PROVISION
The legislative instrument defines a benefit and an exclusion package for which a member of the scheme may have access. Service providers wishing to provide services to members of the scheme have to apply to the NHIC for accreditation and licensing to provide a specified set of services from the benefit package according to their assessed competency.

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