Table 1 Main features of Ghana NHIS

Funding

National Health Insurance Fund (NHIF) established to pay for:

▪ Subsidies to schemes

▪ Reinsurance for schemes

▪ Cost of enrolling the indigent

▪ Supporting access to health care

Funds to come from:

▪ National Health Insurance Levy (NHIL) – 2.5% of V.A.T.

▪ Payroll deductions (2.5% of income) for formal sector

▪ employees

▪ Other funds voted by Parliament, income from investments, any donations, or loans

In addition, DHMIS will raise funds from premia for informal sector members, to be set by agreement with the National Health Insurance Authority (NHIA)

Membership

Membership is mandatory (either via the DHMIS or a private insurance policy). Formal sector workers have involuntary payroll deductions (SSNIT contributions). Informal sector are charged premia which should be income-related. Initially, there is a six-month gap between joining and being eligible for benefits.

Exemptions

Some groups will be exempt from paying for membership (originally SSNIT pensioners, over-70s, under-18s where both parents are members; indigents). The NHIA will transfer subsidies to cover the cost of their enrolment. An indigent is defined as someone who meets four criteria:

▪ is unemployed and has no visible source of income;

▪ does not have a fixed place of residence according to standards determined by the scheme;

▪ does not live with a person who is employed and who has a fixed place of residence; and

▪ does not have any identifiable consistent support from another person.

Benefits package

All providers must offer a minimum package, which is specified and broad. National Health Insurance Drug List is established. 95% of all health care is covered – all services are included other than: rehabilitation other than physiotherapy; appliances and prostheses; cosmetic surgery; HIV retroviral drugs; assisted reproduction; echocardiography; photography; angiography; orthoptics; kidney dialysis; heart and brain surgery other than those resulting from accidents; cancer treatment other than cervical and breast cancer; organ transplantation; non-listed drugs; treatment abroad; medical examinations for visas etc.; VIP wards; and mortuary services.

Eligible providers

All providers are eligible, once accredited. Accreditation is reviewed every five years. Quarterly reports to be sent to the NHIC by providers.

Providers are to be paid within four weeks of claim being made to DMHIS.

Organisation

National Health Insurance Authority (NHIA) established to regulate the market, including accreditation of providers, agreeing contribution rates with schemes, resolving disputes, managing the NHIF, and approving cards.

Each district to have a DMHIS (with a minimum of 2,000 members). Benefits to be transferable across district schemes. Each DHMIS to submit annual reports to NHIA and to undertake annual audit of accounts.

Private MHIS not eligible for subsidies from NHIA.

Accountability

National Health Insurance Council (NHIC) established to oversee NHIA and licence schemes (every two years). Includes representatives of main stakeholder groups, such as Ministry of Health, Ghana Health Services, regulatory bodies, consumers, and Executive Secretary of the NHIA. Chair and Executive Secretary appointed by the President.

NHIC proposes formula for allocation of funds to Parliament for annual approval, and provides annual report to Parliament on its use of funds.

Each DHMIS governed by a Board.

Rules established for handling complaints against providers or schemes.