Essay from the year 2018 in the subject Health - Health system, grade: 85.0, University of Ghana, Legon (Department of Political Science), course: Public Adminstration, language: English, abstract: Policy evaluation involves six primary criteria; and this paper examined these criteria vis-à-vis the Ghana's National Health Insurance Scheme (NHIS) policy in Ghana. Policy evaluation is a very important tool for assessing progress of policy, projects and programmes implementation. It involves a number of processes including, central analysis and preparation of ideas about values, objectives, priorities and claims about facts and cause-effect linkages. This enable analysts to produce valuations about past or possible future actions by public agencies.

In 2003 the Government of Ghana established a National Health Insurance Scheme (NHIS) to improve health care access for Ghanaians and eventually replace the cash and-carry system. This study evaluates the NHIS to determine whether it is fulfilling its purpose in the context of the Millennium Development Goals #4 and #5 which deal with the health of women and children. We use Propensity Score Matching techniques to balance the relevant background characteristics in our survey data and compare health outcomes of recent mothers who are enrolled in the NHIS with those who are not. Our findings suggest that NHIS women are more likely to receive prenatal care, deliver at a hospital, have their deliveries attended by trained health professionals, and experience less birth complications. We conclude that NHIS is an effective tool for increasing health care access, and improving health outcomes.

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.

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.

Bachelor Thesis from the year 2010 in the subject Economics - Macro-economics, general, , course: ACTUARIAL SCIENCE, language: English, abstract: The research reviewed the National Health Insurance Scheme and accessed the possibility of a single premium for decade. The whole research had its foundations from the specific objectives which were; to access the possibility of a single premium for a decade that is feasible enough to sustain the scheme, to identify alternative means of generating income to sustain the Kassena- Nankana District Mutual Health Scheme and to assess the perception of registered and potential clients on the NHIS. The research design employed was statistical survey and both qualitative and quantitative data were collected from a sample of fifty respondents. The research study has its justification from the current government’s intention to implement a single premium system for the NHIS. The main hypothesis that “A single premium is feasible to improve healthcare in Ghana” was accepted with some few actuarial assumptions being made. The research findings emphasized the inclusion of age distribution as key variable to avoid all ages paying the same premium. Problem like moral hazards was addressed in this study and advocacy was suggested as a way of curbing it down. The administrative and accounting systems of NHIS must be fully computerized to help reduce the stress of working manually. Advocacy was also suggested as a solution to the problem of clients going for medications for non registered clients with their NHIS card. Keywords; Insurance, Single premium, Health Inurance, Premium.

This volume analyzes Ghana s National Health Insurance Scheme and highlights the range of policy options needed to assure its financially sustainable transition to universal coverage.