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.

Ghana is one of only several African countries to enact legislation and earmark financing for universal health insurance coverage for its entire population. Seven years into its implementation the Ghana National Health Insurance Scheme (NHIS) has made significant progress in transitioning to universal coverage, but faces significant fiscal and coverage challenges. This study reviews Ghana's health financing system with a special emphasis on its National Health Insurance Scheme. Such an assessment is important because Ghana is often considered a global 'good practice' in terms of earmarking significant amounts of its general revenues for health insurance coverage, providing formal coverage to its vulnerable population groups, and extending coverage by transitioning its existing community health insurance schemes into a national health insurance program. In addition to the global interest in the Ghana 'model', this review is timely in view of recent critiques of the system and questions about its financial sustainability. The study is also unique in terms of evaluating Ghana's NHIS in terms of basic health system goals of health outcomes, financial protection, consumer satisfaction, equity, efficiency, and financial sustainability. The strengths and weaknesses of Ghana's health financing system are assessed on the basis of these performance goals to provide the current health policy reform baseline. The assessment is also based on several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro economy. It also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection/equity of the system at both macro and micro levels; and, contains an extensive fiscal space analysis based on Ghana's new macroeconomic realities (i.e., the revaluation of Ghana's Gross Domestic Product (GDP) upward by some 60 percent in November 2010, making Ghana a lower middle income country). The study concludes with an assessment of potential structural and operational reform options to assure NHISs long-term efficacy and sustainability in the context of its future available fiscal space.

This book presents the health reform experiences over the past three decades of twelve small and medium-sized nations that are not often included in international comparative studies in this field. The major conclusion of the study is that despite many similarities in policy goals, policy challenges and in the menu of policy options for countries that seek to offer universal coverage to their population, the health reforms of the nations in this book did not converge into one direction or model. However, we found several widespread policy experiences that are relevant for others, too.For example, user fees are unpopular everywhere. Governments often try to soften the consequences by exempting large groups of users, thus largely defeating the very purpose of those fees.As a second example, the introduction of new payment modes for medical care — like the shift from fee for service to case-based payment — took much longer than originally expected everywhere, and also failed to deliver their promises of improved transparency or efficiency gains A third example is that proposals are for universal coverage often ignore the challenges of implementing new financing models that elsewhere took decades if not centuries to develop.The conclusions contain both empirical findings and theoretical conclusions of interest to policy-makers and scholars of international comparison. It is accessible for academics, healthcare managers and students as well as a wider audience of readers interested in the changes in healthcare across the world.

Healthcare financing the world over has been of great concern to both developed and developing countries. Thus, policies on how to finance and provide healthcare to an entire nation to include both the formal and informal sectors, rural and urban areas in low-and-middle-income countries is a huge challenge for most developing countries. However, in Sub-Saharan Africa countries, health care financing policies has been in crisis mainly because of the frequent occurrence of political instability coupled with severe economic constraint and lack of good governance. The prominence of these setbacks in financing healthcare among sub-Saharan African countries has lead policies developed on health care spending to be strategised around various transitory national objectives. This study reviews the health financing policies in Ghana between late 1950s and early 2000s. It presents an extensive review of health financing policies and reforms in Ghana over the past 50 years, the conditions under which those strategies were executed and the impact of international health policies on national health objectives. The study further reviews how these national health financing policies have impacted on access to healthcare and services.

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.

This volume analyzes Ghana s health system performance and highlights the range of policy options needed to improve health system performance and health outcomes.

This report reviews Ghana's health financing system with a special emphasis on its National Health Insurance Scheme (NHIS). Such an assessment is important since Ghana is often considered a global 'good practice' as it is one of only a handful of African emerging market countries to actively start implementing universal health insurance coverage by providing formal coverage to its vulnerable population groups. Ghana's NHIS has evolved rapidly by transitioning its existing community health insurance schemes into a national health insurance program supported by significant amounts of earmarked national government revenues. In addition to the global interest in the Ghana 'model', this review is timely in view of a recent critique of the system and call to abandon it in favor of a National Health Service (NHS) as well as the availability of several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro-economy. The study also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection and equity of the system at both macro and micro levels; and, contains an extensive fiscal space analysis based on Ghana's new macroeconomic realities (i.e., a 60 plus percent higher (Gross Domestic Product (GDP) as of November 2010).