National Health Insurance Scheme (Ghana)

Birth of Ghana's National Health Insurance Scheme

The idea for the National Health Insurance Scheme (NHIS) in Ghana was conceived by former president John Kufuor who when seeking the mandate of the people in the 2000 elections, promised to abolish the cash and carry system of health delivery. Under the cash and carry system, the health need of an individual was only attended to after initial payment for the service was made. Even in cases when patients had been brought into the hospital on emergencies it was required that money was paid at every point of service delivery.

Upon becoming president, former president Kufuor pushed through his idea of getting rid of “cash and carry” and replacing it with an equitable insurance scheme that ensured that treatment was provided first before payment for Ghanaian citizens. In 2003, the scheme was passed into law. Under the law, there was the establishment of Ghana National Health Insurance Authority which licenses, monitors and regulates the operation of health insurance schemes in Ghana. Like many countries in the world, Ghana's health insurance was fashioned out to meet specific needs of Ghanaian citizens.

The National Health Insurance Scheme is a form of National health insurance established by the Government of Ghana. The scheme provides equitable access and financial coverage for basic health care services to the Ghanaian population. The objective of the NHIC is to secure the implementation of the national health insurance policy that ensures access to basic healthcare services to all residents of Ghana.

NHIS Policy

The health insurance was set up to allow Ghanaian citizens to make contributions into a fund so that in the event of illness Ghanaian contributors could be supported by the fund to receive affordable health care. Under this policy, three types of health insurance schemes were set up. They were:

In order for the system to function well, the government decided to support the District Mutual Health Insurance Scheme concept to ensure that:

Premiums

Like all insurance schemes, different types of premiums are available under the country's NHIS. Ghanaian contributors are grouped according to their levels of income. Based on the group a Ghanaian contributor may fall in, there is specific premium that ought to be paid. This was done since the socio-economic condition scheme contributors is not the same and the Ghanaian contributions was to be affordable for all to ensure that nobody is forced to remain in cash and carry system. This meant that Ghanaian contributions payable could vary from one district to the other as even the disease burden was also not the same in all the districts. To ensure that all Ghanaian citizens made some contribution to the scheme, a 2.5% Health Insurance Levy on selected goods and services was passed into law so that the money collected could be put into a National Health Insurance Fund to subsidize fully paid contributions to the District Health Insurance Schemes.

Nature of the Scheme

In order to ensure the continuity of the scheme, two major lists were made. One had the all the conditions that the scheme could cover with the other the excluded conditions.

Diseases covered under the scheme

The Government came out with a minimum benefit package of diseases which every district-wide scheme was to cover for Ghanaian citizens. This package covered about 95% of diseases in Ghana. Diseases covered included among others:

However, all district-wide schemes were given the right under the law to organise their schemes to cover as many diseases and services for Ghanaian citizens as they desire, provided it was approved by the National Health Insurance Council.

Exclusive list

Certain diseases were however excluded from the benefit package because it was considered to be too expensive to treat. Therefore, other arrangements had to be considered to enable Ghanaian citizens get these diseases treated. Diseases currently not covered are:

All these constitute only 5% of the total number of diseases that Ghanaian citizens suffered from.

Scheme coverage

The government supports all 212 Districts, Municipal and Sub-metro schemes in Ghana for Ghanaian citizens to the various districts to facilitate the set-up of the schemes.

Controversies

Since the inception of the scheme in 2003, there have been a lot of controversies surrounding its operation and purpose. The first one was to do with members of the opposition National Democratic Congress (NDC), whose members claimed that the scheme was one made for members of the then ruling New Patriotic Party (NPP). As such many members of NDC did not want to register with the scheme. The reverse of all the propaganda that surrounded the scheme at its inception were revisited in 2009 when the NDC took over power. Currently, the controversy with the scheme has to do with the proposed one-time premium payment. This idea was included in the ruling party's manifesto. The promise has so far not come into fruition as the date for its implementation is constantly postponed. Many critics of the proposal claim that it is just not possible to support the scheme with a one-time premium since the sustainability of the scheme would not be possible if premiums were not paid yearly.