Abstract
National health insurance (NHI) is a financing mechanism established by a national government with the goal of covering all or almost all of its citizens. A number of low- and middle-income countries have established NHIs as part of a strategy to progress towards universal health coverage. The establishment of an NHI presents a potentially significant shift in national health sector governance, but little is available in the literature regarding how policymaking authority and health governance is shared between NHIs and ministries of health (MOHs). To answer this question, we conducted a descriptive, qualitative comparative analysis of policies, including legislation, guidelines and webpages, from four sub-Saharan African countries that have established or are in the process of establishing an NHI scheme as of 2019 (Ghana, Kenya, Zambia and South Africa). We developed a novel conceptual framework comprising 16 NHI policy domains and conducted a deductive review of relevant policies. We then extracted and indexed policy elements according to this framework to facilitate comparative analysis. We found substantial variation across countries in the types of policies developed and the decision-making authority around those policies. MOHs in all four countries retained at least some decision-making power over the NHIs through regulations and appointment of board members. However, NHIs were often delegated policymaking authority in key areas including financing mechanisms, provider payments, member payments, benefit schemes, accreditation and relationships with private health insurance schemes. The results of this analysis illustrate many aspects of health regulatory power and oversight that will need to be defined as part of establishing NHIs. The approaches from these four countries and the conceptual framework presented in this manuscript may be helpful for other countries in evaluating differing approaches to shared health governance between NHIs and MOHs.
Highlights
In 2005 the World Health Assembly adopted a resolution that urged member states to ensure that health financing systems included a method for prepayment to pool funding and share risk
Data extraction and analysis Data extraction and analysis was guided by a conceptual framework of National health insurance (NHI) characteristics and the policymaking power of national health insurance schemes (Table 4). This framework was informed by the World Health Organization (WHO) key design features in developing social health insurance systems, WHO Health System Framework, WHO Regional Essential Public Health Functions, Ministry of Health enabling legislation, and peer reviewed studies related to policy, governance, and national health insurance scheme analyses [7, 24, 26,27,28,29,30,31,32]
Domains underpinning policymaking in National Health Insurance Schemes This section synthesizes the study findings related to the policy areas that are relevant to implementing an NHI
Summary
In 2005 the World Health Assembly adopted a resolution that urged member states to ensure that health financing systems included a method for prepayment to pool funding and share risk. The resolution was an effort to achieve universal health coverage (UHC) through population and service coverage and financial risk protection [1]. Services that may require out-of-pocket payments include inpatient care bed charges, consultation fees with the healthcare providers or payments for medicines [6]. National health insurance (NHI) is one possible mechanism for raising and pooling funds to improve access to healthcare across populations while minimizing financial hardship due to health expenditures [7, 8]. The insurance scheme background, structure, and current stage are described below for Ghana, Kenya, Zambia, and South Africa
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
