Publication: Health Financing in Ghana at a Crossroads
Loading...
Published
2012-01-01
ISSN
Date
2012-03-19
Author(s)
Editor(s)
Abstract
This report reviews Ghana's health financing system with a special emphasis on its National Health Insurance Scheme (NHIS). Such an assessment is important since Ghana is often considered a global 'good practice' as it is one of only a handful of African emerging market countries to actively start implementing universal health insurance coverage by providing formal coverage to its vulnerable population groups. Ghana's NHIS has evolved rapidly by transitioning its existing community health insurance schemes into a national health insurance program supported by significant amounts of earmarked national government revenues. In addition to the global interest in the Ghana 'model', this review is timely in view of a recent critique of the system and call to abandon it in favor of a National Health Service (NHS) as well as the availability of several new and updated sources of information on: total health spending, inputs, outcomes, household spending, and the macro-economy. The study also undertakes for the first time an extensive international benchmarking analysis; assesses the financial protection and equity of the system at both macro and micro levels; and, contains an extensive fiscal space analysis based on Ghana's new macroeconomic realities (i.e., a 60 plus percent higher (Gross Domestic Product (GDP) as of November 2010).
Link to Data Set
Citation
“World Bank. 2012. Health Financing in Ghana at a Crossroads. © World Bank. http://hdl.handle.net/10986/2729 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Analyzing Changes in Health Financing Arrangements in High-Income Countries : A Comprehensive Framework Approach(World Bank, Washington, DC, 2007-02)This review is one in a series of analytic efforts designed to inform the policy debate related to health financing. The authors review evidence on health financing arrangements in high income countries as well as reforms over the last 30 years and to identify key policy lessons from this experience for low and middle income countries. Methodology: The review is based on a conceptual framework of health financing "functions". 25 high-income countries have been grouped for comparative evaluative purposes into three groups, based on the main mechanism of financing health care (social health insurance, taxes, private). Decisions on coverage and benefit entitlements as well as various functions of health care financing (i.e. collecting, pooling and purchasing) are described and analyzed.Publication Peruvian Education at a Crossroads : Challenges and Opportunities for the 21st Century(Washington, DC, 2001-05)Peru has reached a crossroads for education policy at the beginning of the 21st century. The status quo reflects major accomplishments. One direction for policy would, therefore, involve useful but relatively limited improvements in the current situation. This direction, however, may prove inadequate to fulfill the country's goal of having a highly educated citizenry--fully competitive by international standards--to underpin poverty reduction and to facilitate economic and social development. A second generation of reform would be required if this direction were taken. This study explores these issues and lays out options for a second wave of reform. Either of the broad directions for policy will need to identify specific ways of improving educational quality. This report analyzed the factors affecting fourth graders' mathematics achievement levels in 1996 to identify options to improve quality. The findings are encouraging in indicating potential directions where change could make a difference. The analysis found that after controlling for a number of explanatory variables, the performance of poor and extremely poor departments was better than non-poor departments of education. To level the playing field for all Peruvian children, then, it is necessary to improve equity, quality, and efficiency in planning and policy.Publication Albania Public Finance Review : Part 2. Improving the Efficiency and Quality of Public Spending(Washington, DC, 2014-05)Albania's rapid growth in the decade up to the 2008 global financial crisis propelled it to middle-income status and helped to reduce poverty. The global financial crisis in 2008 slammed the brakes on Albania's largely domestic-demand-driven growth. The government has accumulated sizable arrears in payments for public works and value-added tax (VAT) refunds. In a baseline scenario of no policy reforms, Albania's public debt-to-gross domestic product (GDP) ratio is projected to reach 73.5 percent in 2015 and stay above 72 percent over the medium term. Empirical evidence confirms that high public debt depresses economic activity and significantly increases the probability of default. This report examines closely the opportunities for fiscal consolidation on both the revenue and expenditure sides. Combined effect of structural reforms will reduce Albania's public debt to GDP ratio significantly over the medium term. It can in parallel rebalance its capital spending, particularly in transport, toward maintenance to support growth. Albania needs to strengthen its institutions to reinforce financial discipline and strengthen fiscal policy. Institutional reforms are particularly needed with regard to public financial management (PFM) and introducing a fiscal rule to anchor policy over the medium term.Publication Health Financing in Ghana(Washington, DC: World Bank, 2012-08-10)The report is divided into five chapters. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. It also describes Ghana's health financing system. Chapter two assesses the performance of Ghana's health system with respect to these goals through international comparisons of health outcomes, inputs, spending, and financial protection as well as time series comparisons of trends in other countries in Africa. Chapter three identifies the strengths and weaknesses of Ghana's health system, which determine Ghana's health reform baseline. Chapter four analyzes the sustainability of the National Health Insurance Scheme, or NHIS in the context of Ghana's future fiscal space, based on Ghana's new standing as a lower-middle-income country. Chapter five analyzes major structural and operational reform options that will help ensure the long-term efficacy and sustainability of the NHIS.Publication China : Improving Rural Public Finance for the Harmonious Society(Washington, DC, 2007-11-21)This report aims to assist the government in improving implementation of the New Socialist Countryside (NSC) program, especially in raising the effectiveness of public expenditures, and the harmonization of public finance. While this report pays particular attention to rural aspects of public finance, it addresses this topic within the overall framework of intergovernmental finance that impacts both rural and urban areas. Similarly, the discussions and recommendations in this report are intended to move the system towards one that is harmonized and does not differentiate between 'rural' and 'urban' areas. The structure of this report is as follows: Chapter 2 analyzes the considerable number of reform efforts that have been introduced to the rural public finance system. It looks at the RFR in depth, as well as other associated and related reforms and evaluates the overall outcome of these reforms. Chapter 3 provides an overview of China's intergovernmental system as the framework for rural public finance. It includes an analysis of the expenditure and revenue assignments and their development, and the impact on rural public finance. The transfer system, an integral part of the intergovernmental fiscal system, is treated separately in Chapter 4 because of its overwhelming importance for rural public finance. The chapter analyzes how far the transfer system goes in addressing the fiscal imbalances and providing the necessary public funds for rural areas. It also assesses the role of earmarked transfers. Chapter 5 then looks at the public finance situation at the grassroots level, i.e., the financing of villages, townships, and counties, including how recent developments have impacted their situation and what remaining issues exist at these levels. Finally, Chapter 6 summarizes the findings of this study, proposes a strategy for policy reforms, and suggests ideas for its implementation.
Users also downloaded
Showing related downloaded files
Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Address before the Foreign Policy Association, Minneapolis, January 19, 1949(World Bank, Washington, DC, 1949-01-19)John J. McCloy, President of the International Bank for Reconstruction and Development, spoke about the elusive matter of international economic recovery. He reviewed the policy environment for the European Recovery Program (Marshall Plan), economic integration, and international trade imbalances. Europe’s dollar problem is America’s dollar problem.Publication Address Presenting the Fourth Annual Report(World Bank, Washington, DC, 1949-09-13)Eugene R. Black, President of the International Bank for Reconstruction and Development, spoke about the plight of the underdeveloped member countries. Bank has greatly enlarged its knowledge of their economic problems and needs, their capacity to absorb and service external loans, and the merits of particular development projects. He discussed the most constructive contributions the Bank can make to the progress of development, especially in the least advanced countries, is to help make available to them the experience of other nations. He closed on a note that the Bank can start on the way towards equilibrium, it may find the effects of returning confidence highly cumulative and the difficulties dispelled more quickly than they dared hope.Publication Common Sense and Economic Aid(World Bank, Washington, DC, 1956-02-18)Eugene R. Black, President of the International Bank for Reconstruction and Development, spoke about America economic aid to other countries. He described in detail the Bank’s business of economic development. The Bank can help developing countries to make a choice in their own interests. He described a hydroelectric power project in Egypt.Publication Address before the Twenty-First Session of the Economic and Social Council of United Nations, New York City(World Bank, Washington, DC, 1956-04-18)Eugene R. Black, President of the International Bank for Reconstruction and Development, discussed the newest development in the Bank's technical assistance work, including the International Finance Corporation. He explained the significant progress made by Bank in the postwar decade, and the continued and intensified efforts to accelerate the pace of development.