National Health Insurance Scheme, Ghana by
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1 National Health Insurance Scheme, Ghana by RUBY SAAKOR TETTEH 10/06/11 1
2 Overview Sources of Funding Insurance Types Exemptions Registered Members Implementation Status Scheme Operation Challenges Way Forward? 10/06/11 2
3 Overview o Late 1950s , health care was free o By 1970, sustainability of free healthcare became problematic - dispensing fee of 15 cent was introduced but immediately withdrawn due to public outcry o In 1983 surcharges was introduced for imported drugs and hospital equipment 10/06/11 3
4 Overview Cont. o In 1985 Government introduced the Cash and Carry System that established user fees for all medical conditions o Except persons above 70 years, children under five and pregnant women. Later full cost recovery for drugs o Until 2004 when the National Health Insurance Scheme (NHIS) was introduced under Act 650 of
5 Sources of Funding Premiums from subscribers 2½% National Health Insurance Levy from VAT Payments 2½% of the 17.5% Social Security and National Insurance Trust (SSNIT), deductions from formal sector Funds from Government 10/06/11 5
6 District Mutual Health Insurance Schemes (DMHIS) Operational in every District Public non-commercial scheme Covers the indigent Receive regular funding from Government Private Mutual Health Insurance Schemes(PMHIS) Comprises private commercial health insurance schemes Operated by approved companies Do not receive subsidy Required to pay a security deposit Private Commercial Health Insurance Schemes (PMHIS) Any group of people (say members of a church) Make contributions to cater for health needs Provide 10/06/11 services approved by the Governing Council 6
7 Exemptions Children less than 18 years whose parents or guardians are contributors Residents 70 years and over in the informal sector Pensioners who are formal sector contributors to SSNIT 10/06/11 7
8 Registered Members YEAR ACTIVE MEMBERS H O S P I T A L ADMISSIONS ENCOUNTERS ,912 28, ,422, , ,275, , ,064, , ,123, ,765 (Jan-Sept.) 10/06/11 8 Source: Operations Directorate of National Health Insurance Authority
9 Implementation Status 1.Schemes In Operation Total Number Of Subscribers 14,282,620 3.Percentage(%) Of Population Registered 69.93% (2000 Base Yr.) 4.Total Id Card Bearers 12,123,338 5.Id Card Bearers As % Of Total Registered 84.9% about 30 percent still not registered 10/06/11 9
10 Scheme Operation Treatment and offering of services without payment Bills sent to your scheme provider which then pays to hospital Prescribed drugs at accredited pharmacies or licensed chemical shops Services covered include outpatient consultations, essential drugs, inpatient care and shared accommodation, maternity, eye, dental and emergency Covers 95% of the disease burden in Ghana Excluded Ailments - echocardiography, renal dialysis, 10/06/11 10 heart and brain surgery, organ transplant, and HIV retroviral
11 Challenges Lack of Access delay in issuance of id cards Delayed claims reimbursement 3-4 months instead of a month Exclusion of some effective drugs from the medicines list due to high market prices Frequent or multiple attendance by patients for same ailment NHIS members spend longer waiting time due to cumbersome documentation and large attendance Reports of hospitals and pharmacies turning patients away, complaining that the public health insurance schemes owes them huge amounts of money. Huge sums of money to Schemes without being accountable Massive fraudulent claims facilitated by a collusion of the schemes and some healthcare providers. 10/06/11 11
12 Way Forward Improvement in health infrastructure and equipment Enhance capacity of human resources to cope with the increasing subscription and attendance. Incentives for health professionals and posting to places where they are inadequate Need to capture disaggregated data on women, men, persons with disability, boys, girls, indigents etc Increase level of awareness - educate stakeholders on the operations of the Scheme. NHIA should produce simplified operations manual for the public Schemes should find innovative ways to track membership expiration and renewals to assess actual status of members Purchase of quality medicine for the scheme while NHIS Pay for market prices 10/06/11 12
13 National Health Insurance Scheme Website Send-Ghana, May 2010 Balancing Access with Quality Health Care: An Assessment of the NHIS in Ghana ( ) UNDP Ghana and National Development Planning Commission, April 2010 Forever Young Tuesday, August 16, /06/11
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