National Health Insurance Scheme in Ghana: Reforms
Author : trish-goza | Published Date : 2025-06-27
Description: National Health Insurance Scheme in Ghana Reforms Achievements International Conference Centre Accra Ghana November 2013 Sylvester A Mensah Chief Executive NHIA 10 years of Financial Access to Quality Healthcare Towards
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Transcript:National Health Insurance Scheme in Ghana: Reforms:
National Health Insurance Scheme in Ghana: Reforms & Achievements International Conference Centre, Accra, Ghana November, 2013 Sylvester A. Mensah (Chief Executive, NHIA) 10 years of Financial Access to Quality Healthcare. “Towards Universal Health Coverage: Increasing Enrolment whilst Ensuring Sustainability” Contents Overview Operational Performance 2 Milestones Achievements Challenges & Way Forward Overview 3 4 The NHIS was established by an Act of Parliament in 2003 (Act 650). Initiative by Government to secure financial risk protection against the cost of healthcare services for all residents in Ghana. Act was revised in 2012 – NHIS Act 850 Major Characteristics of NHIS 5 Funding - Combination of the following models Beveridgean: National Health Insurance levy - 2.5% VAT Bismarckian: 2.5 percentage points of Social Security contributions MHO: Graduated informal sector premium based on ability to pay Earmarked funds (NHIL & SSNIT) constitute over 90% of total inflows Benefit package covers 95% of disease conditions Major Characteristics of NHIS 6 Significant revisions in the Law include the following: A Mandatory NHIS A Unified NHIS with District Offices Premium exemptions for persons with Mental Disorders Expenditure cap of 10% on non-core NHIS activities Relevant family planning package Board oversight committee for i. Scheme Operations ii. Private Health Insurance schemes iii. Fund Management The New NHIS Act 2012 (Act 852) 7 MINISTRY OF HEALTH (MOH) PURCHASER (NHIS) PROVIDERS (Public & Private) SUBCRIBER Provision of quality services Utilization of services Stewardship (Policy & Regulation) Submission of Claims Payment of Claims Pays Premium Ensure provision of quality services Key Players in NHIS Architecture 8 Revenue Sources & Allocation (Act 852) NHIL (2.5% VAT) Interest on Fund (Investment Income) Ministry of Finance National Health Insurance Fund (NHIF) Admin. & General Expenses of NHIA Support to the Ministry of Health [Capped @ 10%] Payment to Healthcare Providers Premium & Registration Fees Other Income Workmen’s compensation Road Accident Fund SSNIT Contributions (2.5% of payroll) District Offices of the NHIA Payments to Health care Providers Transfers for Claims Pmt 8 8 I. Overview 9 Provider Payment Mechanism A mix of provider payment mechanisms: FEE FOR SERVICE Medicines G-DRG Secondary & Tertiary care CAPITATION* Primary care* Medicines Services 2005 FFS G-DRG for outpatient & inpatient services Capitation for outpatient primary care G-DRG for inpatient, outpatient specialist and emergency care. FFS FFS FFS 2008 2012 MDG 1 Poverty & Hunger MDG 4 Child Mortality MDG 5 Maternal Health MDG 6 HIV/AIDS, Malaria & TB Free
