Abstract :
[en] In 2003, Ghana introduced National Health Insurance Scheme (NHIS) to provide financial access to healthcare for all residents. It was implemented in 2004 in 145 districts nationwide. This study aimed to evaluate the NHIS in terms of health financing sub-functions of revenue collection, risks pooling, and purchasing of health care using the Ashiedu Keteke District NHIS Office as a case study.
The review and participant observation methods were employed to analyze secondary data of the NHIS. Reviews were conducted on NHIS operational documents, annual reports, and published literature. A data compilation sheet was used to collect membership, revenue and expenditure data from the AshieduKeteke District NHIS Office.
Out of 158,466 members who registered over the period under study (2005-2012), about 30% were active card-bearing members. The population coverage increased consistently from 6.4% to 29.9% over the study period. Children below eighteen years of age were the most registered members (42.2%). Membership is legally mandatory and household-based. The NHIS is largely tax-funded: prepaid contributions declined from 20% to 15.4% over the study period. There was multiple fund system between 2005 and 2009; however, in 2011, a single risk pool (single fund system) was implemented to maximize risk pooling and administrative efficiency. There is comprehensive one-for-all benefit package for ensuring equity and adequate financial protection. The provider payment mechanism changed from fee-for-service in 2005 to Diagnostic Related Groupings (DRG) in 2008; although, fee-for-service is still used to pay for medications. In 2011, capitation payment was implemented for out-patient services at primary health centers. The administrative expenditure is relatively high; however, it declined from 42.1% to 13.3% over the period, 2006- 2012.
The population coverage of the Ashiedu Keteke District NHIS Office is increasing with a decreasing trend in administrative expenditure. Given that more than fifty percent of the membership groups are exempted from paying contributions and the extent of prepayment is declining, large scope of government subsidies would be needed to ensure long-term financial sustainability.
