Funding
Population Covered
Service delivery system
Institutional structure
In 2004, Ghana embarked on a process of developing and implementing a National Health Insurance Scheme (NHIS) to replace out-of-pocket fees at point of service. The solution was a ‘hub-satellite’ model of a national fund and authority (the hub) that regulates and subsidizes a national network of community-based health insurance schemes (CBHIs) (the satellites).
In 2004, Ghana embarked on a process of developing and implementing a National Health Insurance Scheme (NHIS) to replace out-of-pocket fees at point of service. The solution was a ‘hub-satellite’ model of a national fund and authority (the hub) that regulates and subsidizes a national network of community-based health insurance schemes (CBHIs) (the satellites).
As the vast majority of Ghanaians work in the informal economy, it was recognized early on that a state sponsored statutory social health insurance (SHI) scheme would most likely be unsustainable in Ghana. Consequently, the NPP appointed two task teams to design a system that allowed for the inclusion of informal workers. As the vast majority of Ghanaians work in the informal economy, it was recognized early on that a state sponsored statutory social health insurance (SHI) scheme would most likely be unsustainable.
The NHIS is interesting in that it has adapted the SHI model so that informal workers can be included into the scheme. This has been done by fusing elements of SHI with elements of Community Based Health Insurance (CBHI). By combining a network of CBHI schemes with a centralized authority and source of funds (the SHI component) to ensure nationwide coverage and to guarantee the financial sustainability of the schemes, the NHIS has attempted to adapt the best aspects of these two very different health financing models to fit the particular socio-economic landscape of Ghana.
Government policy objectives in setting up the NHIS are stated in the national health insurance policy framework for Ghana as: ‘Ultimately, the vision of government in instituting a health insurance scheme . . . is to assure equitable and universal access for all residents of Ghana to an acceptable quality package of essential healthcare. The policy objective is ‘‘within the next five years, every resident of Ghana shall belong to a health insurance scheme that adequately covers him or her against the need to pay out of pocket at the point of service use in order to obtain access to a defined package of acceptable quality of health service’’.’
As of October 2008, the NHIS had insured 12 million people out of a total population of 21 million (61% of the total population).
National Health Insurance Scheme (NHIS)
Reform summary
In 2004, Ghana embarked on a process of developing and implementing a National Health Insurance Scheme (NHIS) to replace out-of-pocket fees at point of service. The solution was a ‘hub-satellite’ model of a national fund and authority (the hub) that regulates and subsidizes a national network of community-based health insurance schemes (CBHIs) (the satellites).
As the vast majority of Ghanaians work in the informal economy, it was recognized early on that a state sponsored statutory social health insurance (SHI) scheme would most likely be unsustainable in Ghana. Consequently, the NPP appointed two task teams to design a system that allowed for the inclusion of informal workers. As the vast majority of Ghanaians work in the informal economy, it was recognized early on that a state sponsored statutory social health insurance (SHI) scheme would most likely be unsustainable.
The NHIS is interesting in that it has adapted the SHI model so that informal workers can be included into the scheme. This has been done by fusing elements of SHI with elements of Community Based Health Insurance (CBHI). By combining a network of CBHI schemes with a centralized authority and source of funds (the SHI component) to ensure nationwide coverage and to guarantee the financial sustainability of the schemes, the NHIS has attempted to adapt the best aspects of these two very different health financing models to fit the particular socio-economic landscape of Ghana.
Government policy objectives in setting up the NHIS are stated in the national health insurance policy framework for Ghana as: ‘Ultimately, the vision of government in instituting a health insurance scheme . . . is to assure equitable and universal access for all residents of Ghana to an acceptable quality package of essential healthcare. The policy objective is ‘‘within the next five years, every resident of Ghana shall belong to a health insurance scheme that adequately covers him or her against the need to pay out of pocket at the point of service use in order to obtain access to a defined package of acceptable quality of health service’’.’
As of October 2008, the NHIS had insured 12 million people out of a total population of 21 million (61% of the total population).
The NHIF is financed from several different sources. Approximately 70% of total funding comes from a health insurance levy added to VAT, 23% comes from contributions made by formal sector workers to the Social Security and National Trust (SSNIT), and 5% comes from Premium payments. Members do not pay deductibles or copayments when accessing health care.
The NHIF is financed from several different sources. Approximately 70% of total funding comes from a health insurance levy added to VAT, 23% comes from contributions made by formal sector workers to the Social Security and National Trust (SSNIT), and 5% comes from Premium payments. Members do not pay deductibles or copayments when accessing health care.
Each funding source is described in further detail below:
- A 2.5% health insurance levy added to VAT
- 2.5% of the 17.5% Social Security and National Trust (SSNIT) contribution made by formal sector employees (the 17.5% contribution is made up of a 12.5% contribution from employers and 5% contribution from employees)
- Member premiums of between 7.20 to 48.00 Ghana cedis annually (USD5.00 – USD34.00)
- Money that accrues to the fund from investments made by the NHIC Other:
- Funds allocated to the scheme by the Government of Ghana via Parliament
- The central exemptions fund, formerly used to provide exemptions from user fees for those classed as ‘indigent’
- Donor funds (few details on these donor funds are available)
The NHIS is a hybrid of social and community based health insurance models. The basic structure of the NHIS is described as a “hub-satellite” model. The “hub” of the system, which is essentially based on the SHI model of pooled public tax resources, is the National Health Insurance Fund (NHIF) which is administered by the National Health Insurance Authority (NHIA). The “satellites” are a country wide network of CBHI schemes known as District Wide Mutual Health Insurance (DWMHI) schemes which are monitored, subsidized and re-insured by the “hub.”
The table below presents estimates and projections for the composition of NHIS income from 2008 to 2018.
| 2008 | 2009 | 2010 | 2011 | 2012 | 2018 | |
|---|---|---|---|---|---|---|
| SSNIT members | 58.86 | 59.51 | 76.82 | 94.41 | 117.86 | 327.03 |
| Health insurance levy | 176.56 | 213.64 | 256.37 | 302.52 | 352.44 | 836.70 |
| Insurance premiums (DMHIS) | 13.05 | 20.89 | 27.53 | 35.77 | 45.63 | 171.46 |
| Investment income | 5.53 | 48.53 | 51.04 | 49.56 | 45.07 | 0.00 |
| Other income | 0.05 | 0.05 | 0.07 | 0.08 | 0.09 | 0.24 |
| Total | 254.05 | 342.63 | 411.94 | 482.76 | 561.99 | 1,335.43 |
At present, employers are not held to anything in terms of contributions other than ensuring the necessary SSNIT deductions are made from the payrolls of formal sector employees. However, the NHIC has apparently made it known that it would prefer employers to contribute a sum equal to that of the employee’s contribution.
The NHIA has set the DWMHI annual premium levels at a minimum of 7.20 Ghana cedis and a maximum of 48.00 Ghana cedis (approximately $5-$34 in 2009) per adult member, to be determined by income status. The NHIA website states that this can be paid as a lump sum, or in 12 monthly installments (www.nhis.gov.gh). In practice, varying flat premiums are paid by districts across the country, with rich districts paying higher than poor districts.
The recent return to power of the NDC in the 2008/2009 elections may signal a significant change in the premium structure, however. The new government is considering the possibility of instituting a one-time premium that would guarantee access to the NHIS for life. Although no definite figures have been given as yet, rumor has it that the life time premium may be in the range of 150 Ghana cedis (just over $100), although the figure of $10-12 is also heard.
National Health Insurance Scheme (NHIS)
Funding
The NHIF is financed from several different sources. Approximately 70% of total funding comes from a health insurance levy added to VAT, 23% comes from contributions made by formal sector workers to the Social Security and National Trust (SSNIT), and 5% comes from Premium payments. Members do not pay deductibles or copayments when accessing health care.
Each funding source is described in further detail below:
- A 2.5% health insurance levy added to VAT
- 2.5% of the 17.5% Social Security and National Trust (SSNIT) contribution made by formal sector employees (the 17.5% contribution is made up of a 12.5% contribution from employers and 5% contribution from employees)
- Member premiums of between 7.20 to 48.00 Ghana cedis annually (USD5.00 – USD34.00)
- Money that accrues to the fund from investments made by the NHIC Other:
- Funds allocated to the scheme by the Government of Ghana via Parliament
- The central exemptions fund, formerly used to provide exemptions from user fees for those classed as ‘indigent’
- Donor funds (few details on these donor funds are available)
The NHIS is a hybrid of social and community based health insurance models. The basic structure of the NHIS is described as a “hub-satellite” model. The “hub” of the system, which is essentially based on the SHI model of pooled public tax resources, is the National Health Insurance Fund (NHIF) which is administered by the National Health Insurance Authority (NHIA). The “satellites” are a country wide network of CBHI schemes known as District Wide Mutual Health Insurance (DWMHI) schemes which are monitored, subsidized and re-insured by the “hub.”
The table below presents estimates and projections for the composition of NHIS income from 2008 to 2018.
| 2008 | 2009 | 2010 | 2011 | 2012 | 2018 | |
|---|---|---|---|---|---|---|
| SSNIT members | 58.86 | 59.51 | 76.82 | 94.41 | 117.86 | 327.03 |
| Health insurance levy | 176.56 | 213.64 | 256.37 | 302.52 | 352.44 | 836.70 |
| Insurance premiums (DMHIS) | 13.05 | 20.89 | 27.53 | 35.77 | 45.63 | 171.46 |
| Investment income | 5.53 | 48.53 | 51.04 | 49.56 | 45.07 | 0.00 |
| Other income | 0.05 | 0.05 | 0.07 | 0.08 | 0.09 | 0.24 |
| Total | 254.05 | 342.63 | 411.94 | 482.76 | 561.99 | 1,335.43 |
At present, employers are not held to anything in terms of contributions other than ensuring the necessary SSNIT deductions are made from the payrolls of formal sector employees. However, the NHIC has apparently made it known that it would prefer employers to contribute a sum equal to that of the employee’s contribution.
The NHIA has set the DWMHI annual premium levels at a minimum of 7.20 Ghana cedis and a maximum of 48.00 Ghana cedis (approximately $5-$34 in 2009) per adult member, to be determined by income status. The NHIA website states that this can be paid as a lump sum, or in 12 monthly installments (www.nhis.gov.gh). In practice, varying flat premiums are paid by districts across the country, with rich districts paying higher than poor districts.
The recent return to power of the NDC in the 2008/2009 elections may signal a significant change in the premium structure, however. The new government is considering the possibility of instituting a one-time premium that would guarantee access to the NHIS for life. Although no definite figures have been given as yet, rumor has it that the life time premium may be in the range of 150 Ghana cedis (just over $100), although the figure of $10-12 is also heard.
Each Ghanaian district has a District Wide Mutual Health Insurance (DWMHI) scheme, and each metropolis has two such schemes. Contributions to SSNIT are automatic for members of the DWMHIs. The DWMHI schemes have their own management structures and a certain level of autonomy in the setting of premiums and other costs, although these have to be kept within the limits established by the NHIA. As with the other CBHI schemes, membership is voluntary, although there are plans to eventually introduce compulsory membership.
Each Ghanaian district has a District Wide Mutual Health Insurance (DWMHI) scheme, and each metropolis has two such schemes. Contributions to SSNIT are automatic for members of the DWMHIs. The DWMHI schemes have their own management structures and a certain level of autonomy in the setting of premiums and other costs, although these have to be kept within the limits established by the NHIA. As with the other CBHI schemes, membership is voluntary, although there are plans to eventually introduce compulsory membership.
The DWMHI schemes have their own management structures and have a certain level of autonomy in the setting of premiums and the charging of other costs, although these have to be kept within the limits established by the NHIA.
As one of the reasons for the NHIS’s existence is to stop out-of-pocket healthcare payments, there are no deductibles, and no copayments have to be made by NHIS members when accessing healthcare. As one of the reasons for the NHIS's existence is to stop out-of-pocket healthcare payments, there are no deductibles and no copayments.
Enrollment: Contributions to SSNIT are automatic for members of DWMHI schemes because of the health insurance deductions made from their SSNIT contributions, and are only required to pay an initial registration fee. The premium structure therefore applies only to those who work in the informal economy or who are not SSNIT contributors. These members pay their premiums to the DWMHI schemes directly. The schemes employ collectors who move between houses and market stalls to receive premium payments.
Alternatively, premiums can be paid to banks, or to designated pharmacies or ‘chemical shops.’ Premiums can be paid at any time during the year – there is no set registration period.
Exemptions: Exemptions from premium payments exist for SSNIT contributors, SSNIT pensioners, those over the age of 70, and for those classed as indigent. Indigents are classified as those people who:
- Have no visible source of income
- Have no fixed abode
- Are not living with an employed person with a fixed abode
- Have no consistent source of support from another person
Currently all children under the age under 18 are exempted from NHIS premium payments irrespective of the NHIS membership status of their parents. If parents are NHIS members, then children are covered for free. However, if parents are not NHIS members, children cannot access benefits.
National Health Insurance Scheme (NHIS)
Population covered
Each Ghanaian district has a District Wide Mutual Health Insurance (DWMHI) scheme, and each metropolis has two such schemes. Contributions to SSNIT are automatic for members of the DWMHIs. The DWMHI schemes have their own management structures and a certain level of autonomy in the setting of premiums and other costs, although these have to be kept within the limits established by the NHIA. As with the other CBHI schemes, membership is voluntary, although there are plans to eventually introduce compulsory membership.
The DWMHI schemes have their own management structures and have a certain level of autonomy in the setting of premiums and the charging of other costs, although these have to be kept within the limits established by the NHIA.
As one of the reasons for the NHIS’s existence is to stop out-of-pocket healthcare payments, there are no deductibles, and no copayments have to be made by NHIS members when accessing healthcare. As one of the reasons for the NHIS's existence is to stop out-of-pocket healthcare payments, there are no deductibles and no copayments.
Enrollment: Contributions to SSNIT are automatic for members of DWMHI schemes because of the health insurance deductions made from their SSNIT contributions, and are only required to pay an initial registration fee. The premium structure therefore applies only to those who work in the informal economy or who are not SSNIT contributors. These members pay their premiums to the DWMHI schemes directly. The schemes employ collectors who move between houses and market stalls to receive premium payments.
Alternatively, premiums can be paid to banks, or to designated pharmacies or ‘chemical shops.’ Premiums can be paid at any time during the year – there is no set registration period.
Exemptions: Exemptions from premium payments exist for SSNIT contributors, SSNIT pensioners, those over the age of 70, and for those classed as indigent. Indigents are classified as those people who:
- Have no visible source of income
- Have no fixed abode
- Are not living with an employed person with a fixed abode
- Have no consistent source of support from another person
Currently all children under the age under 18 are exempted from NHIS premium payments irrespective of the NHIS membership status of their parents. If parents are NHIS members, then children are covered for free. However, if parents are not NHIS members, children cannot access benefits.
The basic benefits package is fairly extensive and purports to cover 95% of all health problems reported in Ghanaian health care facilities, though there is a noticeable emphasis on female reproductive health. Expensive, highly specialized care such as dialysis and organ transplants are not covered by the NHIS. ARVs for the treatment of HIV/AIDS are also not covered as these drugs are supplied by a separate government program.
The basic benefits package is fairly extensive and purports to cover 95% of all health problems reported in Ghanaian health care facilities, though there is a noticeable emphasis on female reproductive health. Expensive, highly specialized care such as dialysis and organ transplants are not covered by the NHIS. ARVs for the treatment of HIV/AIDS are also not covered as these drugs are supplied by a separate government program.
The health services covered by the NHIS are laid out in the minimum basic benefits package. The list also delineates prescribed medicines. Benefits for maternity care include antenatal care, caesarean sections, and postnatal care for up to six months after birth. Treatment for breast and cervical cancer are included in the package, although treatment for other cancers is not.
NHIS Benefits Package
Outpatient services
- General and specialist consultation services
- General and specialist diagnostic testing, including laboratory investigation, X-rays, ultrasound scanning
- Medicines on the NHIS medicines list
- Surgical operations such as hernia repair
- Physiotherapy
Inpatient services
- General and specialist inpatient care
- Diagnostic tests
- Medication - prescribed medicines on the NHIS medicines list, blood and blood products
- Surgical operations
- Inpatient physiotherapy
- Accommodation in the general ward
- Feeding (where available)
Oral health
- Pain relief (tooth extraction, temporary incision and drainage)
- Dental restoration (simple amalgam filling, temporary dressing)
Maternity care
- Antenatal care
- Deliveries (normal and assisted)
- Caesarean section
- Postnatal care
Emergencies
- Medical emergencies
- Surgical emergencies
- Pediatric emergencies
- Obstetric and gynecological emergencies
- Road traffic accident
Exclusions list
- Appliance and prostheses including optical aids, heart aids, orthopedic aids, dentures, etc.
- Cosmetic surgeries and aesthetic treatment
- HIV retroviral drugs
- Assisted reproduction (e.g., artificial insemination) and gynecological hormone replacement therapy
- Echocardiography
- Photography and angiography
- Dialysis for chronic renal failure
- Organ transplantation
- All drugs not listed on the NHIS list
- Heart and brain surgery other than those resulting from accidents
- Cancer treatment other than breast and cervical
- Mortuary services
- Diagnosis and treatment abroad
- Medical examinations for purposes other than treatment in accredited health facilities
- VIP ward accommodation
National Health Insurance Scheme (NHIS)
Benefits package
The basic benefits package is fairly extensive and purports to cover 95% of all health problems reported in Ghanaian health care facilities, though there is a noticeable emphasis on female reproductive health. Expensive, highly specialized care such as dialysis and organ transplants are not covered by the NHIS. ARVs for the treatment of HIV/AIDS are also not covered as these drugs are supplied by a separate government program.
The health services covered by the NHIS are laid out in the minimum basic benefits package. The list also delineates prescribed medicines. Benefits for maternity care include antenatal care, caesarean sections, and postnatal care for up to six months after birth. Treatment for breast and cervical cancer are included in the package, although treatment for other cancers is not.
NHIS Benefits Package
Outpatient services
- General and specialist consultation services
- General and specialist diagnostic testing, including laboratory investigation, X-rays, ultrasound scanning
- Medicines on the NHIS medicines list
- Surgical operations such as hernia repair
- Physiotherapy
Inpatient services
- General and specialist inpatient care
- Diagnostic tests
- Medication - prescribed medicines on the NHIS medicines list, blood and blood products
- Surgical operations
- Inpatient physiotherapy
- Accommodation in the general ward
- Feeding (where available)
Oral health
- Pain relief (tooth extraction, temporary incision and drainage)
- Dental restoration (simple amalgam filling, temporary dressing)
Maternity care
- Antenatal care
- Deliveries (normal and assisted)
- Caesarean section
- Postnatal care
Emergencies
- Medical emergencies
- Surgical emergencies
- Pediatric emergencies
- Obstetric and gynecological emergencies
- Road traffic accident
Exclusions list
- Appliance and prostheses including optical aids, heart aids, orthopedic aids, dentures, etc.
- Cosmetic surgeries and aesthetic treatment
- HIV retroviral drugs
- Assisted reproduction (e.g., artificial insemination) and gynecological hormone replacement therapy
- Echocardiography
- Photography and angiography
- Dialysis for chronic renal failure
- Organ transplantation
- All drugs not listed on the NHIS list
- Heart and brain surgery other than those resulting from accidents
- Cancer treatment other than breast and cervical
- Mortuary services
- Diagnosis and treatment abroad
- Medical examinations for purposes other than treatment in accredited health facilities
- VIP ward accommodation
In order to provide the basic package of services, NHIS covers both public and private health care providers at all levels of the health system, subject to their accreditation by the NHIA. As of December 2009, 966 private, 1,368 public and 163 CHAG providers were enrolled in NHIS.
In order to provide the basic package of services, NHIS covers both public and private health care providers at all levels of the health system, subject to their accreditation by the NHIA. As of December 2009, 966 private, 1,368 public and 163 CHAG providers were enrolled in NHIS.
At present all public facilities have been given a provisional accreditation and 800 private providers (many of them pharmacies and ‘chemical shops’) have been accredited by the NHIA.
National Health Insurance Regulations (LI 1809, Regulation 19 (1)) state that the first point of attendance for accessing health care under the NHIS should be a primary healthcare facility. This includes CHPS, health centers, district hospitals, polyclinics, quasi public hospitals, private hospitals, clinics and maternity homes. Where the only facility is a Regional Hospital, it will also be considered a primary healthcare facility. In emergencies, any accredited healthcare facility may be utilized.
National Health Insurance Scheme (NHIS)
Service delivery system
In order to provide the basic package of services, NHIS covers both public and private health care providers at all levels of the health system, subject to their accreditation by the NHIA. As of December 2009, 966 private, 1,368 public and 163 CHAG providers were enrolled in NHIS.
At present all public facilities have been given a provisional accreditation and 800 private providers (many of them pharmacies and ‘chemical shops’) have been accredited by the NHIA.
National Health Insurance Regulations (LI 1809, Regulation 19 (1)) state that the first point of attendance for accessing health care under the NHIS should be a primary healthcare facility. This includes CHPS, health centers, district hospitals, polyclinics, quasi public hospitals, private hospitals, clinics and maternity homes. Where the only facility is a Regional Hospital, it will also be considered a primary healthcare facility. In emergencies, any accredited healthcare facility may be utilized.
The National Health Insurance Authority is the national governing body of the NHIS. Each DWMHI scheme is managed by a Board, which is elected by a General Assembly comprised of Community Health Insurance Committee (CHIC) representatives. Monitoring is carried out at all levels, including by the NHIS, district schemes, and health care providers.
The National Health Insurance Authority is the national governing body of the NHIS. Each DWMHI scheme is managed by a Board, which is elected by a General Assembly comprised of Community Health Insurance Committee (CHIC) representatives. Monitoring is carried out at all levels, including by the NHIS, district schemes, and health care providers.
See Figure 1 below for an illustrative depiction of the institutional structure of the NHIS.
Its mandate is “to secure the implementation of a national health insurance policy that ensures basic healthcare services to all residents.” Section 3 of the Act establishes the governing body of the Authority, known as the National Health Insurance Council (NHIC), which administers the National Health Insurance Fund. The President of Ghana is given sole power to appoint the chairperson and members of the Council.
CHIC representatives represent geographically determined ‘Health Insurance Communities’ within each district. The CHIC exists officially to oversee the collection of contributions within its designated Health Insurance Community, to supervise the deposit of these into the District Health Insurance Fund, and to represent community interests in the management structures of the DWMHIS.
The figure below presents an illustrative depiction of the financial structure of the NHIS, including sources of cash flow and the organizational structure of the management of NHIS financial resources.
National Health Insurance Scheme (NHIS)
Institutional structures
The National Health Insurance Authority is the national governing body of the NHIS. Each DWMHI scheme is managed by a Board, which is elected by a General Assembly comprised of Community Health Insurance Committee (CHIC) representatives. Monitoring is carried out at all levels, including by the NHIS, district schemes, and health care providers.
See Figure 1 below for an illustrative depiction of the institutional structure of the NHIS.
Its mandate is “to secure the implementation of a national health insurance policy that ensures basic healthcare services to all residents.” Section 3 of the Act establishes the governing body of the Authority, known as the National Health Insurance Council (NHIC), which administers the National Health Insurance Fund. The President of Ghana is given sole power to appoint the chairperson and members of the Council.
CHIC representatives represent geographically determined ‘Health Insurance Communities’ within each district. The CHIC exists officially to oversee the collection of contributions within its designated Health Insurance Community, to supervise the deposit of these into the District Health Insurance Fund, and to represent community interests in the management structures of the DWMHIS.
The figure below presents an illustrative depiction of the financial structure of the NHIS, including sources of cash flow and the organizational structure of the management of NHIS financial resources.
In 2004, a memorandum of understanding regarding the services covered and prices charged was signed by the NHIC and service provider representatives. Claims are filed by the health facilities and the district schemes pay providers on a DRG basis. Typically, a reimbursement check comes 6 months after a claim is submitted.
In 2004, a memorandum of understanding regarding the services covered and prices charged was signed by the NHIC and service provider representatives. Claims are filed by the health facilities and the district schemes pay providers on a DRG basis. Typically, a reimbursement check comes 6 months after a claim is submitted.
This memorandum now forms the basis of all contracts between the health schemes and providers. Claims processing is a manual process, with some automation in enrollment verifications and claims documentation.
The amount of the reimbursement is often less than 100%, with some schemes, for example, paying 70% (e.g., Ossu Kottery – urban scheme in higher income area of Accra), others paying as low as 40% (e.g., Dodowah, rural area outside Accra). The balance is supposed to be paid at later date.
National Health Insurance Scheme (NHIS)
Provider payment mechanisms
In 2004, a memorandum of understanding regarding the services covered and prices charged was signed by the NHIC and service provider representatives. Claims are filed by the health facilities and the district schemes pay providers on a DRG basis. Typically, a reimbursement check comes 6 months after a claim is submitted.
This memorandum now forms the basis of all contracts between the health schemes and providers. Claims processing is a manual process, with some automation in enrollment verifications and claims documentation.
The amount of the reimbursement is often less than 100%, with some schemes, for example, paying 70% (e.g., Ossu Kottery – urban scheme in higher income area of Accra), others paying as low as 40% (e.g., Dodowah, rural area outside Accra). The balance is supposed to be paid at later date.
Many independent evaluations of the Ghanaian NHIS are ongoing, including evaluations carried out by the Ministry of Health. There has been a rapid increase in the numbers of people registered with the NHS since its inception in 2003. Additionally, the NHIS’ introduction also appears to have increased utilization of formal health facilities – one of the major goals of the scheme.There has been a rapid increase in the numbers of people registered with the NHIS since its inception in 2003.
Many independent evaluations of the Ghanaian NHIS are ongoing, including evaluations carried out by the Ministry of Health. There has been a rapid increase in the numbers of people registered with the NHS since its inception in 2003. Additionally, the NHIS’ introduction also appears to have increased utilization of formal health facilities – one of the major goals of the scheme.There has been a rapid increase in the numbers of people registered with the NHIS since its inception in 2003.
Regarding the increase in people registered, it is important to recognize that registration statistics do not give a wholly accurate picture of the scheme’s reach. Only those with valid ID cards are able to actually access NHIS benefits.
Regarding increased utilization of facilities, use of outpatient and inpatient department services almost doubled between 2005 and September 2007, according to the Ministry of Health (2008). However, the Ministry of Health report does not make it clear whether this was a reflection of an increase in the number of people using health services, or whether it was the number of visits to health services that increased.
National Health Insurance Scheme (NHIS)
Monitoring and evaluation
Many independent evaluations of the Ghanaian NHIS are ongoing, including evaluations carried out by the Ministry of Health. There has been a rapid increase in the numbers of people registered with the NHS since its inception in 2003. Additionally, the NHIS’ introduction also appears to have increased utilization of formal health facilities – one of the major goals of the scheme.There has been a rapid increase in the numbers of people registered with the NHIS since its inception in 2003.
Regarding the increase in people registered, it is important to recognize that registration statistics do not give a wholly accurate picture of the scheme’s reach. Only those with valid ID cards are able to actually access NHIS benefits.
Regarding increased utilization of facilities, use of outpatient and inpatient department services almost doubled between 2005 and September 2007, according to the Ministry of Health (2008). However, the Ministry of Health report does not make it clear whether this was a reflection of an increase in the number of people using health services, or whether it was the number of visits to health services that increased.