Something old or something new? Social health insurance in Ghana
Sophie Witter,Bertha Garshong +1 more
TLDR
Some trade-offs will be necessary between the existing wide benefits package of the NHIS and the laudable desire to reach universal coverage, and the overall resource envelope for health is likely to be stable rather than increasing over the medium-term.Abstract:
There is considerable interest at present in exploring the potential of social health insurance to increase access to and affordability of health care in Africa. A number of countries are currently experimenting with different approaches. Ghana's National Health Insurance Scheme (NHIS) was passed into law in 2003 but fully implemented from late 2005. It has already reached impressive coverage levels. This article aims to provide a preliminary assessment of the NHIS to date. This can inform the development of the NHIS itself but also other innovations in the region. This article is based on analysis of routine data, on secondary literature and on key informant interviews conducted by the authors with stakeholders at national, regional and district levels over the period of 2005 to 2009. In relation to its financing sources, the NHIS is heavily reliant on tax funding for 70–75% of its revenue. This has permitted quick expansion of coverage, partly through the inclusion of large exempted population groups. Card holders increased from 7% of the population in 2005 to 45% in 2008. However, only around a third of these are contributing to the scheme financially. This presents a sustainability problem, in that revenue is de-coupled from the growing membership. In addition, the NHIS offers a broad benefits package, with no co-payments and limited gate-keeping, and also faces cost escalation related to its new payment system and the growing utilisation of members. These features contributed to a growth in distressed schemes and failure to pay outstanding facility claims in 2008. The NHIS has had a considerable impact on the health system as a whole, taking on a growing role in funding curative care. In 2009, it is expected to contribute 41% of the overall resource envelope. However there is evidence that this funding is not additional but has been switched from other funding channels. There are some equity concerns about this, as the new funding source (a VAT-based tax) may be more regressive. In addition, membership of the NHIS at present has a pro-rich bias, and a pro-urban bias in relation to renewals. Only a very small proportion is registered as indigent, and there is some evidence of 'squeezing out' of non-members from health care utilisation. Finally, considerable challenges remain in relation to strengthening the purchasing role of the NHIS, and also settling debates about its structure and accountability. Some trade-offs will be necessary between the existing wide benefits package of the NHIS and the laudable desire to reach universal coverage. The overall resource envelope for health is likely to be stable rather than increasing over the medium-term. In the longer term, the investment costs in the NHIS will only be justified if it is able to increase the cost-effectiveness of purchasing and the responsiveness of the system as a whole.read more
Citations
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Journal ArticleDOI
Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia
TL;DR: Nine low-income and lower-middle-income countries in Africa and Asia that have implemented national health insurance reforms designed to move towards universal health coverage are analyzed.
Journal ArticleDOI
The effect of Ghana's National Health Insurance Scheme on health care utilisation.
TL;DR: It is found that on average individuals enrolled in the insurance scheme are significantly more likely to obtain prescriptions, visit clinics and seek formal health care when sick.
Journal ArticleDOI
Removing user fees in the health sector: a review of policy processes in six sub-Saharan African countries
Bruno Meessen,David Hercot,Mathieu Noirhomme,Valéry Ridde,Abdelmajid Tibouti,Christine Kirunga Tashobya,Lucy Gilson +6 more
TL;DR: There is now a window of opportunity in many African countries for policy action to address barriers to accessing health care, and it is argued that national policy-makers and international agencies could better collaborate in this respect.
Journal ArticleDOI
The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts
TL;DR: Findings from this study confirm the positive financial protection effect of health insurance in Ghana, stronger among the poor group than among general population, and are encouraging for many low income countries who are considering a similar policy to expand social health insurance.
Journal ArticleDOI
A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?
TL;DR: Ability of the NHIS to continue its operations in Ghana is threatened financially and operationally by factors such as: cost escalation, possible political interference, inadequate technical capacity, spatial distribution of health facilities and health workers, inadequate monitoring mechanisms, broad benefits package, large exemption groups, inadequate client education, and limited community engagement.
References
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Journal ArticleDOI
Household catastrophic health expenditure: a multicountry analysis.
TL;DR: People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection.
Journal ArticleDOI
Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme
Irene Akua Agyepong,Samuel Adjei +1 more
TL;DR: This case study supports observations from the literature that although availability of evidence is critical, major public social policy and programme content can be heavily influenced by factors other than the availability or non-availability of evidence to inform content decision making.
Journal ArticleDOI
A price to pay: The impact of user charges in ashanti-akim district, Ghana
TL;DR: The rural population in the Ashanti-Akim district of Ghana seems to have suffered a disproportionate drop in utilization since the introduction of user charges and some people simply cannot afford services.
Journal ArticleDOI
Beyond fragmentation and towards universal coverage: insights from Ghana, South Africa and the United Republic of Tanzania
Diane McIntyre,Bertha Garshong,Gemini Mtei,Filip Meheus,Michael Thiede,James Akazili,Mariam Ally,Moses Aikins,Jo-Ann Mulligan,Jane Goudge +9 more
TL;DR: The analysis suggests that South Africa has made the least progress in addressing fragmentation, while Ghana appears to be pursuing a universal coverage policy in a more coherent way.
Journal ArticleDOI
Health for some? The effects of user fees in the Volta Region of Ghana.
Frank Nyonator,Joseph Kutzin +1 more
TL;DR: The study found that facility managers have been very active in setting and collecting fees and using the revenues to purchase essential inputs, and achieved a kind of 'sustainable inequity', with fees enabling service provision to continue, while concurrently preventing part of the population from using these services.
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