Delivering on the NHIS Promise NATIONAL HEALTH INSURANCE AUTHORITY

Transcription

1 NATIONAL HEALTH INSURANCE AUTHORITY MOBILISING THE PRIVATE SECTOR TO DEVELOP A SUSTAINABLE HEALTHCARE ECONOMY IN AFRICA Thursday, 23 October 2008 Amsterdam, The Netherlands BY RAS A. BOATENG (CHIEF EXECUTIVE) 1

2 Outline Of Presentation Delivering on the NHIS Promise Overview of Health Insurance Act New Institutional Framework Private Sector Participation Status of Implementation Challenges Strategic Initiatives 2

3 Overview Of Health Insurance Act ACT 650 NATIONAL HEALTH INSURANCE COUNCIL TYPES OF HEALTH INSURANCE SCHEMES NATIONAL HEALTH INSURANCE FUND Implement NHI Policy Register, license & Regulate HIS Grant accreditation to Healthcare Providers Determine Premiums Manage NHI Fund Promote Health Education Establishment of District Mutual Health Insurance Establishment of Private Commercial Health Insurance Establishment of Private Mutual Health Insurance Education Programs Subsidize Cost to DMHIS Reinsure DMHIS against cost fluctuations Fund Indigent Healthcare cost Provide access to health service

4 New Institutional Framework SSNIT Insured Members Premiums -Manage NHI fund -Register, license & regulate DMHIS -Determine Premiums Health Insurance Levy Transfer of Funds HUB NHIC & Secretariat implementer of National Health Insurance Policy Other Funds -Grant accreditation to Healthcare Providers -Promote Health Education Transfer of subsidy, reinsurance and technical support through offices to Satellites G. Accra Volta Ashanti Eastern Western Central Northern B.A U. East U. West G. Accra District - 10 Volta District - 15 Ashanti District - 24 Eastern District - 17 Western District - 15 Central District - 13 Northern District - 18 B.A District - 19 U. East District - 6 U. West DMHIS - 8 Insured Persons Pay Premium ( 72, , 000 per annum) Directly to DMHIS SERVICE PROVIDERS Hospitals, Pharmacies, Laboratories, Chemical Shops, etc

5 Private Sector Contribution to the growth of Health Insurance in Ghana 1993: Nationwide Mutual Medical Insurance Scheme (by the Private Medical Practitioners Association; reached subscriber base of 20,000 people in 2 years, corporate subscribers paid premia annually, half yearly or quarterly and was based on the benefits level) 1997: Metropolitan Health Insurance Plan (by Metropolitan Insurance company Ltd., As at September 2001, 15,000 subscribers were on full cover, 25,000 on partial cover. Over 100 companies had subscribed. Had designed a package for the educational sector workers and was working with Defence to design one for the Civilian workers/dependants of the Military) 1999: The Ghana Healthcare Company (by SSNIT but still at gestation period) The Nkoranza Community based Mutual Health Scheme

6 Private Sector Participation in NHIS Implementation (Financing side) Gemini Life Insurance Company Vanguard Assurance Momentum Health Insurance

7 Private Sector Participation in NHIS Implementation (Provider side) Category of Providers Number Accredited Hospitals/Clinics 311 Dental Clinics 5 Maternity Homes 203 Pharmacies 345 Chemical Shops 322 Diagnostic Centres/Imaging 91 Total Accredited 1,277

8 Percentage Market Share of Health Service Provision Service Provider Number of Facilities Percentage Percentage HR Ghana Health Service and Teaching Hospitals 1, Faith Based Providers Private Hospitals and Clinics & Maternity Homes Quasi

9 Status of Implementation Schemes in operation 145 Total Registered 11,656,352 57% Total Active Members ,542 49% Total ID Card Bearers 10,433,441 51% Categories, numbers and % to Total Active Members Informal Adult 3,803,478 38% Aged 774,436 8% Under 18 5,617,159 56% SSNIT Contributors 902,571 9% Pensioners 65,853 1% Indigents 275,379 3% Pregnant Women 217,476 2%

10 Status of Implementation (Cont d) YEAR Hospital/Clinic Attendance Active Members ,000 1,388, ,213,450 3,955, ,835,104 8,291, (As at June,08) 3,500,678 10,036,542

11 Challenges of the Private Sector in Health The financing side: initial capitalisation, e.g. the security deposit Provider side: disincentive in locating at hard to reach areas Initial capitalisation Technical Personnel

12 Proposed strategies to address challenges Incentivise private providers to operate in hard to reach areas. Use of accreditation of existing private providers to redistribute health facilities to improve geographical access Encouraging Ghanaian doctors in Diaspora to relocate and establish modern health facilities in the country through the franchise idea

13 END OF PRESENTATION THANK YOU 13