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Ghana National Health Insurance Scheme

Author

Listed:
  • Huihui Wang
  • Nathaniel Otoo
  • Lydia Dsane-Selby

Abstract

Ghana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.

Suggested Citation

  • Huihui Wang & Nathaniel Otoo & Lydia Dsane-Selby, 2017. "Ghana National Health Insurance Scheme," World Bank Publications - Books, The World Bank Group, number 27658.
  • Handle: RePEc:wbk:wbpubs:27658
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    Citations

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    Cited by:

    1. Elisabeth Paul & N’koué Emmanuel Sambiéni & Jean-Pierre Wangbe & Fabienne Fecher & Marc Bourgeois, 2020. "Budgeting challenges on the path towards universal health coverage: the case of Benin," Health Economics Review, Springer, vol. 10(1), pages 1-8, December.
    2. Patricia Akweongo & Samuel Tamti Chatio & Richmond Owusu & Paola Salari & Fabrizio Tedisio & Moses Aikins, 2021. "How does it affect service delivery under the National Health Insurance Scheme in Ghana? Health providers and insurance managers perspective on submission and reimbursement of claims," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-15, March.
    3. Kwame Adjei-Mantey & Charles Yuji Horioka, 2023. "Determinants of health insurance enrollment and health expenditure in Ghana: an empirical analysis," Review of Economics of the Household, Springer, vol. 21(4), pages 1269-1288, December.
    4. Elisabeth Paul & N'koué Emmanuel Sambiéni & Jean-Pierre Wangbe & Fabienne Fecher & Marc Bourgeois, 2020. "Budgeting challenges on the path towards universal health coverage: the case of Benin," ULB Institutional Repository 2013/312499, ULB -- Universite Libre de Bruxelles.
    5. Dunsch, Felipe Alexander & Velenyi, Edit, 2019. "Job Preferences of Frontline Health Workers in Ghana - A Discrete Choice Experiment," SocArXiv bqx5k, Center for Open Science.
    6. Helena Owusu & Pruthu Thekkur & Jacklyne Ashubwe-Jalemba & George Kwesi Hedidor & Oksana Corquaye & Asiwome Aggor & Allen Steele-Dadzie & Daniel Ankrah, 2022. "Compliance to Guidelines in Prescribing Empirical Antibiotics for Individuals with Uncomplicated Urinary Tract Infection in a Primary Health Facility of Ghana, 2019–2021," IJERPH, MDPI, vol. 19(19), pages 1-14, September.
    7. Adolf Kwadzo Dzampe & Shingo Takahashi, 2022. "Competition and physician-induced demand in a healthcare market with regulated price: evidence from Ghana," International Journal of Health Economics and Management, Springer, vol. 22(3), pages 295-313, September.
    8. Addo, Rebecca & Hall, Jane & Haas, Marion & Goodall, Stephen, 2020. "The knowledge and attitude of Ghanaian decision-makers and researchers towards health technology assessment," Social Science & Medicine, Elsevier, vol. 250(C).
    9. Martin Amogre Ayanore & Milena Pavlova & Nuworza Kugbey & Adam Fusheini & John Tetteh & Augustine Adoliba Ayanore & James Akazili & Philip Baba Adongo & Wim Groot, 2019. "Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana," Health Economics Review, Springer, vol. 9(1), pages 1-15, December.

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