Ghana National Health Insurance Scheme: Improving Financial Sustainability Based on Expenditure Review

Abstract

Since the establishment of Ghana National Health Insurance Scheme (NHIS) in 2003, the government of Ghana has made substantial progress toward its goal of universal health care. This study’s goal is to inform policy makers on improving financial sustainability of the NHIS based on quantitative evidence of claim expenditure patterns. The study generates quantitative evidence on patterns of claims expenditures. It also offers insights into how to strengthen country systems for making evidence-based policies in health sector in general and NHIS in particular. The study examines the NHIS’s basic features and its role in health financing. A statistical analysis at the service-provider and member levels reveals patterns in claims expenditure, highlighting key factors affecting the level and efficiency of NHIS claims expenditures. This book comprises six chapters. Following the introduction, chapter 2 provides an overview of the country context and the key features of the health sector. Chapter 3 describes the NHIS, including its revenue structure, expenditure composition, enrollment information, claims-management system, benefits package, provider-payment system, and accreditation services, as well as a summary of its members’ knowledge of its essential features. Chapter 4 presents the results of an NHIS claims-expenditure review, which includes historical trends at national level, an overview of claims expenditures in the Volta region, the composition of claims expenditures, and variations among service providers and members. Chapter 5 identifies factors that affect the level and efficiency of NHIS claims expenditures, focusing on behaviors of service providers and patients, as well as NHIA internal management. Chapter 6 concludes with a set of recommendations for designing customized policies for efficient spending in Ghana NHIS.