FORUM ON HEALTH FINANCING IN TANZANIA
|
|
|
- Rosalyn Curtis
- 10 years ago
- Views:
Transcription
1 FORUM ON HEALTH FINANCING IN TANZANIA SCALING UP NATIONAL HEALTH INSURANCE SCHEME: GHANA S EXPERIENCE Blue Pearl Hotel, Dar es Salaam 6 th. Sept., 2010
2 THE GHANA TEAM Francis Mensah Asenso-Boadi, PhD Winfred Agbeibor
3 OUTLINE Introduction Policy Objective & Coverage Benefit Package & Exclusions Sources of Financing the NHIS Implementation Status Factors accounting for improved scale up Marketing Strategies Adopted Provider Selection & Reimbursement Challenges Planned Reforms
4 INTRODUCTION NHIS of Ghana was established by the National Health Insurance Act, 2003 (Act 650) and National Health Insurance Regulations, 2004 (L.I. 1809) 3 types of health insurance schemes District mutual schemes (DMHIS) Private mutual schemes Private commercial schemes All regulated by National Health Insurance Authority (NHIA)
5 POPULATION COVERAGE Policy objective To secure the provision of basic healthcare services to persons resident in the country Exempt from premium payment Social Security Contributors (formal sector) SSNIT Pensioners 70 years and above Under 18 Indigents Expectant Mothers (New feature that was initiated in July 2008)
6 NHIS BENEFIT PACKAGE I Out-patient Services Consultations (general & specialist) including reviews Investigations including laboratory investigations, x- rays and ultrasound scanning for general and specialist out-patient services HIV/AIDS symptomatic treatment for opportunistic infection Out-patient/Day Surgical Operations Out-patient Physiotherapy. 6
7 NHIS BENEFIT PACKAGE II Out-patient Services Oral Health Services Eye Care Services Maternity Care (Antenatal; Deliveries, Postnatal) Emergencies (All emergencies shall be covered) 7
8 NHIS BENEFIT PACKAGE III In Patient Services General and Specialist in-patient care Investigations including laboratory investigations, x-rays and ultrasound scanning for in-patient care Cervical and Breast Cancer Treatment Surgical Operations In-patient Physiotherapy Accommodation in general ward Feeding (where available) 8
9 NHIS BENEFIT PACKAGE IV In Patient / Out patient Services Medication, namely, prescription drugs on National Health Insurance Scheme Medicines List, traditional medicines approved by the FDB, blood products 9
10 BENEFIT PACKAGE - EXCLUSIONS Few, notably: Infertility Dialysis for chronic renal failure Anti-retroviral medications Conditions covered by vertical programs Cosmetic Surgery
11 FINANCING THE NHIS Current Sources of funding for NHIS Premiums from subscribers (ranges from GH 7.20 to GH 48 per head with an average of GH 27). 2.5% NHIL 2.5% SSNIT deductions from the formal sector. *Funds from Government of Ghana (GoG) allocated by Parliament Returns on investment Sector Budget Support 11
12 INCOME Health Insurance Levy (2.5% of VAT) SSNIT contributions (2.5% of payroll) Current Cash Flow of Ministry of Finance and Economic Planning NHIS EXPENDITURE Administration logistical support to DMHIS and Interest on Fund Other Income National Health Insurance Fund (NHIF) Managed by NHIA Administration and general expenses of NHIA Support to Partner Institutions Subsidies Reinsurance Premium and registration fees (informal sector ) members District Mutual Health Insurance Schemes (DMHIS) Payment of Claims to Healthcare Providers 12
13 INCOME SOURCES FOR THE NHIS, 2008 NHIS INCOME BY SOURCE 2008 Investment income 11.95% British Gov't Grant 4.83% Insurance Premium 3.74% Other Income 0.01% SSNIT Contribution 17.11% Health Insurance Levy 62.37% 13
14 NHIS TOTAL INFLOW AS AT 31 ST DECEMBER,
15 STATUS OF IMPLEMENTATION (As At June 30, 2010; Population based on 2009 estimate) Schemes in operation 145 Total Registered 15,555,816 % Population Registered 66.4% Total ID Card Bearers 13,943,414 ID Card Bearers as % of Total Registered 89.6% CATEGORIES, NUMBERS AND % TO TOTAL CARD BEARERS Category Number % of ID Card Bearers Informal Adult 4,546, % Aged (>=70 years) 1,006, % Under 18 years 7,604, % SSNIT Contributors 915, % SSNIT Pensioners 81, % Indigents 350, % Pregnant Women 1,051, %
16 TOTAL REGISTERED MEMBERS ,184,294 14,511,777 15,555,816 12,518,560 Series 1 Series 2 Series ,348,160 3,867,
17 ACTIVE MEMBERSHIP active members Axis Title Series Series2-2,526,776 6,774,270 9,969,846 11,132,981 12,632,828
18 INFORMAL MEMBERS Informal Sector 5,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000, ,000 0 Informal Sector
19 UTILIZATION Escalating utilization rates, as measured by the number of outpatient encounters ,603,216 9,967,091 4,952,049 2,569, , Series 1 Series 2 Series 3
20 Factors accounting for the improved scaling up of coverage -I Legal backing ensuring confidence among residents Social nature of the program Intensive public education and community sensitization on the concept Affordability of premium levels Elaborate arrangement to ensure fund flow for implementation
21 Factors accounting for the improved scaling up of coverage -II Dedicated support from NGOs, eg. DANIDA Direct community participation in the management issues of the schemes (community ownership) Role of District Assemblies and keen involvement of DCEs in the program
22 Factors accounting for the improved scaling up of coverage - III Commitment and dedication of staff and Board members of District schemes Encouragement derived from free health care services accessed by cardholders of the scheme Unintended benefits of the HI ID card (card could be valuable in identifying holders in circumstances other than health care)
23 MARKETTING STRATEGIES ADOPTED Door to Door Campaign Dawn and Evening Broadcast Church and Mosque Education Community Durbars Social Gatherings Regular Radio/FM Programmes(talk shows and sponsorship of programmes) Video Show on the benefits of the scheme Circulation of educational material
24 PROVIDERS SELECTION AND REIMBURSEMENT Accreditation of health care facilities by NHIA Contracts between DMHIS and providers Reimbursement mechanism Payments are made to health care facilities, not professionals or subscribers Started with fee for service G-DRG tariffs and NHIS Medicines List Implemented since April 1, 2008 Review: medicines completed and in effect since 1 st October 2009; tariffs review initiated
25 CLAIMS ADMINISTRATION Claims processing by DMHIS Claims reimbursement by DMHIS Premiums collected locally Subsidy from NHIA Reinsurance from NHIA
26 CHALLENGES Implementation Architecture Standardisation and governance challenges Weak portability Career progression issues Claims administration Providers: delays submission; misapplication of tariffs; gaming Schemes: capacity; reimbursement Subscribers indulge in provider shopping and abuse of gatekeeper system
27 Challenges (2) ICT implementation Provider site challenges Scheme site challenges Membership Coverage: vulnerable groups; renewals Quality of care Potential for fraud by member/scheme/provider Misapplication of tariffs and spurious claims
28 GOING FORWARD One-time premium & a legislative review are currently under consideration to scale up universal coverage One-Time Premium: Intended to reduce the lifetime premium Legislative Review:Provides an opportunity for better identifying indigents in the informal sector
29 Thank You
30
Building up Health Insurance: the Experience of Ghana
Building up Health Insurance: the Experience of Ghana Dr. Caroline Jehu-Appiah Ghana Health Service 5 th April 2011, Basel Presentation outline Background Achievements Challenges Success factors Way forward
The National Health Insurance Scheme in Ghana: Best Practices. Regional Conference on Social Health Protection in East African Community
The National Health Insurance Scheme in Ghana: Best Practices Regional Conference on Social Health Protection in East African Community Dr. Lydia Dsane-Selby Director, Clinical Audit National Health Insurance
National Health Insurance Scheme, Ghana by
National Health Insurance Scheme, Ghana by RUBY SAAKOR TETTEH 10/06/11 1 Overview Sources of Funding Insurance Types Exemptions Registered Members Implementation Status Scheme Operation Challenges Way
Social Protection and Healthcare Financing: Ghana s NHIS Experience by Danaa Nantogmah, FES Ghana
Social Protection and Healthcare Financing: Ghana s NHIS Experience by Danaa Nantogmah, FES Ghana Introduction and Background The 2010 provisional census results estimated Ghana s population at 24,233,431
Delivering on the NHIS Promise NATIONAL HEALTH INSURANCE AUTHORITY
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)
NATIONAL/MUTUAL HEALTH INSURANCE IN GHANA INTRODUCTION, ACCESS, FRAMEWORK
NATIONAL/MUTUAL HEALTH INSURANCE IN GHANA INTRODUCTION, ACCESS, FRAMEWORK By Dr. Adobea Yaa Owusu Pro MHI Africa Pro MHI Africa is kindly funded by the ACP-EU Cooperation Programme in Higher Education
Experiences of Ghana s National Health Insurance Scheme: Achievements, Challenges & Way Forward
Experiences of Ghana s National Health Insurance Scheme: Achievements, Challenges & Way Forward Caroline Jehu- Appiah Principal Health Economist African Development Bank (AfDB) June 11 th, 2015 Contents
Who is excluded in Ghana s National Health Insurance Scheme and why: A Social, Political, Economic and Cultural (SPEC)-bystep
Who is excluded in Ghana s National Health Insurance Scheme and why: A Social, Political, Economic and Cultural (SPEC)-bystep Analysis Felix A. Asante; Daniel K. Arhinful; Ama P. Fenny; Anthony Kusi, Gemma
How To Compare Hifi To Hifi
MUTUAL HEALTH INSURANCE VERSUS NATIONAL HEALTH INSURANCE IN GHANA PRO MHI CONFERENCE, LILONGWE, MALAWI, DEC. 2 3, 2009 BY G. ADOBEA OWUSU, PHD MPH, ISSER, UG, LEGON OUTLINE Introduction Objective of study
Comparison of Healthcare Systems in Selected Economies Part I
APPENDIX D COMPARISON WITH OVERSEAS ECONOMIES HEALTHCARE FINANCING ARRANGEMENTS Table D.1 Comparison of Healthcare Systems in Selected Economies Part I Predominant funding source Hong Kong Australia Canada
HEALTH INSURANCE BAROMETER MANUAL
HEALTH INSURANCE BAROMETER PERFORMANCE ASSESSMENT ON GOVERNANCE AND FINANCIAL MANAGEMENT MANUAL SNV GHANA July 2009 2 Table of Contents 1 Introduction...5 1.1 Purpose of the Health Insurance Barometer
Coverage for: Individual Plan Type: PPO. Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important
Most of the workers in the developing world are
WIEGO Policy Brief (Social Protection) N o 9 September 2012 The Ghana National Health Insurance Scheme: Assessing Access by Informal Workers Laura Alfers 1 Most of the workers in the developing world are
Nationwide Life Insurance Company: Ochsner Clinical School Coverage Period: 1/1/15 12/31/15
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chpstudent.com or by calling 1-800-633-7867. Important
An Assessment of the Kwabre District Mutual Health Insurance Scheme in Ghana
Current Research Journal of Social Sciences 4(5): 372-382, 2012 ISSN: 2041-3246 Maxwell Scientific Organization, 2012 Submitted: June 13, 2012 Accepted: July 18, 2012 Published: September 25, 2012 An Assessment
Regence BlueCross BlueShield of Oregon: Regence Oregon Standard Bronze Plan Coverage Period: Beginning on or after 01/01/2014
Regence BlueCross BlueShield of Oregon: Regence Oregon Standard Bronze Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: Beginning on or after 01/01/2014 Coverage
TotalIndependence Silver Plan: Health Republic Insurance of New York Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this
What is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions
RIT Blue Point2 POS B No Drug Coverage Period: 01/01/2016-12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your medical coverage and costs, you can get the complete terms in the policy or plan document at www.excellusbcbs.com or by calling 1-800-499-1275/V.
Student Health Insurance Plan Insurance Company Coverage Period: 07/01/2015-06/30/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
Highmark Health Insurance Company: Health Savings Blue PPO 1300
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 1-888-510-1064.
HMO Blue Basic Coinsurance Coverage Period: on or after 01/01/2015
HMO Blue Basic Coinsurance Coverage Period: on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Family Plan Type: HMO This is only
Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE
Laurus Strategies Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE The Affordable Care Act (ACA) requires non grandfathered health insurance plans in the individual and
National Guardian Life Insurance Company Maine College of Art Student Health Insurance Plan Coverage Period: 09/01/2015-08/31/2016
J3A59 National Guardian Life Insurance Company This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
Highmark Health Insurance Company: Shared Cost Blue PPO 3200
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 1-888-510-1064.
Important Questions Answers Why this Matters: Preferred Provider: $1,000 per Person/2,000 Family
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.wpsic.com or by calling 1-888-915-4001. Important Questions
Highmark Blue Shield: Flex Blue PPO 2100 a Community Blue Plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkblueshield.com or by calling 1-888-510-1084.
BridgeSpan Health Company: BridgeSpan Oregon Standard Gold Plan MyChoice Northwest
BridgeSpan Health Company: BridgeSpan Oregon Standard Gold Plan MyChoice Northwest Summary of Benefits and Coverage: What this Plan Covers & What it Costs Questions: Call 1 (855) 857-9943 or visit us at
How To Pay For Health Care With A Health Care Plan With A Premium Rate Of $1,000 A Year
Regence BlueCross BlueShield of Utah: Regence Direct Silver HSA Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual &
Not applicable because there s no out-of-pocket limit on your expenses. You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.njcf.org or by calling 1-800-624-3096. Important Questions
Important Questions Answers Why this Matters: $3,000/ person $6,000/family Benefits not subject to deductible include: preventive care.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this
Health Alliance Plan. Coverage Period: 01/01/2015-12/31/2015. document at www.hap.org or by calling 1-800-422-4641.
Health Alliance Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage for: Individual+Family Plan Type: HMO This is only a summary.
Gundersen Health Plan: MN NJ Silver $2000-0% Coverage Period: 01/01/2015-12/31/2015
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gundersenhealthplan.org or by calling 1-800-897-1923.
Expatriate Benefits Healthcare Guide NO DEDUCTIBLE
Diamond Plan (Zone C) Worldwide excluding USA, Canada and Switzerland Expatriate Benefits Healthcare Guide NO DEDUCTIBLE Worldwide coverage excluding USA, Canada, and Switzerland Zone C : limited to emergency
Important Questions Answers Why this Matters: What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://knowyourbenefits.dfa.ms.gov or by calling 1-866-586-2781.
Coverage for: Individual/Individual + Family What this Plan Covers & What it Costs
Connecticut General Life Insurance Co.: Open Access 1000 Plan Coverage Period: Beginning on or after 9/23/2012 Coverage for: Individual/Individual + Family What this Plan Covers & What it Costs! This is
Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
: VIVA HEALTH Access Plan Coverage Period: 01/01/2015 12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this
Health CO-OP Oregon Standard Silver Plan: Oregon s Health CO-OP Coverage Period: 1/1/2014-12/31/2014
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://ohcoop.org/benefits-and-coverage or by calling 1-855-722-8207.
HealthyBlue PPO $1500 Coverage Period: 01/01/2014-12/31/2014
HealthyBlue PPO $1500 Coverage Period: 01/01/2014-12/31/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: PPO This is only a summary. If you
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document by calling 1-888-990-5702. Important Questions Answers Why this
In-network: $5,000 per insured/ $10,000 per family per calendar year. Out-of-network: $10,000 per insured / $20,000
Regence BlueShield of Idaho: Coverage Period: Beginning on or after 01/01/2014 Regence Individual Direct Bronze HSA Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for:
PROSPECTS AND CHALLENGES OF THE NATIONAL HEALTH INSURANCE SCHEME IN TOLON DISTRICT OF GHANA
UNIVERSITY FOR DEVELOPMENT STUDIES PROSPECTS AND CHALLENGES OF THE NATIONAL HEALTH INSURANCE SCHEME IN TOLON DISTRICT OF GHANA ELIZABETH ANIAH 2016 i UNIVERSITY FOR DEVELOPMENT STUDIES PROSPECTS AND CHALLENGES
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://newjersey.healthrepublic.us/ or by calling 1-888-990-5706.
Blue Care Elect Preferred 90 Copay Coverage Period: on or after 09/01/2015
Blue Care Elect Preferred 90 Copay Coverage Period: on or after 09/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Only Plan Type: PPO This is only
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.maineoptions.org or by calling 1-855-624-6463. Important
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at http://www.peoplenotprofits.com or by calling 1-888-990-6635.
$0 See the chart starting on page 2 for your costs for services this plan covers. Are there other deductibles for specific
This is only a summary. If you want more detail about your medical coverage and costs, you can get the complete terms in the policy or plan document at www.teamsters-hma.com or by calling 1-866-331-5913.
Coverage for: Individual, Family Plan Type: PPO. Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bbsionline.com or by calling 1-866-927-2200. Important
UMC Health Plan Operations Coverage Period: 01/01/2013-12/31/2013
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at [email protected] or by calling
Blue Care Elect Saver with Coinsurance Northeastern University HDHP Coverage Period: on or after 01/01/2016
Blue Care Elect Saver with Coinsurance Northeastern University HDHP Coverage Period: on or after 01/01/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual
Private Sector Health Actuarial Practice in Malaysia
Private Sector Health Actuarial Practice in Malaysia Please provide an estimate of the number and percentage of full members of your association who practice full-time or part-time as health actuaries.
Boston College Student Blue PPO Plan Coverage Period: 2015-2016
Boston College Student Blue PPO Plan Coverage Period: 2015-2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Family Plan Type: PPO This is only a
National Guardian Life Insurance Company: Earlham College Student Health Insurance Plan Coverage Period: 08/01/2015-07/31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.
Highmark Health Insurance Company: Shared Cost Blue PPO 5500
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.highmarkbcbs.com or by calling 1-800-544-6679. Important
Health. Insurance YOUR GUIDE TO. Life Insurance Association. General Insurance Association of Singapore. Produced by.
Produced by Life Insurance Association General Insurance Association of Singapore YOUR GUIDE TO Health Insurance An initiative of MoneySENSE A National Financial Education Programme for Singapore Introduction
You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.sas-mn.com or by calling 1-800-328-2739. Important Questions