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

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dc.contributor.authorWang, Huihui
dc.contributor.authorOtoo, Nathaniel
dc.contributor.authorDsane-Selby, Lydia
dc.date.accessioned2017-07-31T14:50:52Z
dc.date.available2017-07-31T14:50:52Z
dc.date.issued2017-07-31
dc.description.abstractGhana National Health Insurance Scheme (NHIS) was established in 2003 as a major vehicle to achieve the country’s commitment of Universal Health Coverage. The government has earmarked value-added tax to finance NHIS in addition to deduction from Social Security Trust (SSNIT) and premium payment. However, the scheme has been running under deficit since 2009 due to expansion of coverage, increase in service use, and surge in expenditure. Consequently, Ghana National Health Insurance Authority (NHIA) had to reduce investment fund, borrow loans and delay claims reimbursement to providers in order to fill the gap. This study aimed to provide policy recommendations on how to improve efficiency and financial sustainability of NHIS based on health sector expenditure and NHIS claims expenditure review. The analysis started with an overall health sector expenditure review, zoomed into NHIS claims expenditure in Volta region as a miniature for the scheme, and followed by identifictation of factors affecting level and efficiency of expenditure. This study is the first attempt to undertake systematic in-depth analysis of NHIS claims expenditure. Based on the study findings, it is recommended that NHIS establish a stronger expenditure control system in place for long-term sustainability. The majority of NHIS claims expenditure is for outpatient consultations, district hospitals and above, certain member groups (e.g., informal group, members with more than five visits in a year). These distribution patterns are closely related to NHIS design features that encourages expenditure surge. For example, year-round open registration boosted adverse selection during enrollment, essentially fee-for-service provider mechanisms incentivized oversupply but not better quality and cost-effectiveness, and zero patient cost-sharing by patients reduced prudence in seeking care and caused overuse. Moreover, NHIA is not equipped to control expenditure or monitor effect of cost-containment policies. The claims processing system is mostly manual and does not collect information on service delivery and results. No mechanisms exist to monitor and correct providers’ abonormal behaviors, as well as engage NHIS members for and engaging members for information verification, case management and prevention.en
dc.identifier.doi10.1596/978-1-4648-1117-3
dc.identifier.isbn978-1-4648-1117-3
dc.identifier.urihttps://hdl.handle.net/10986/27658
dc.languageEnglish
dc.language.isoen_US
dc.publisherWashington, DC: World Bank
dc.relation.ispartofseriesWorld Bank Studies;
dc.rightsCC BY 3.0 IGO
dc.rights.holderWorld Bank
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/igo
dc.subjectGHANA
dc.subjectEFFICIENCY
dc.subjectHEALTH INSURANCE
dc.subjectFINANCIAL SUSTAINABILITY
dc.subjectEXPENDITURE CONTROL
dc.subjectHEALTH FINANCING
dc.subjectCOST CONTAINMENT
dc.subjectDEVELOPING COUNTRY
dc.titleGhana National Health Insurance Schemeen
dc.title.subtitleImproving Financial Sustainability Based on Expenditure Reviewen
dc.typeBooken
dc.typeLivrefr
dc.typeLibroes
dspace.entity.typePublication
okr.crossref.titleGhana National Health Insurance Scheme: Improving Financial Sustainability Based on Expenditure Review
okr.date.disclosure2017-07-31
okr.date.doiregistration2025-04-10T02:48:13.001540Z
okr.date.doiregistration2025-04-15T10:47:48.568482Z
okr.doctypePublications & Research
okr.doctypePublications & Research::Publication
okr.guid493641501663722238
okr.identifier.doi10.1596/978-1-4648-1117-3
okr.identifier.doihttps://doi.org/10.1596/978-1-4648-1117-3
okr.identifier.internaldocumentum211117
okr.identifier.report117828
okr.importedtrue
okr.language.supporteden
okr.pdfurlsftp://107.21.26.223:22//sftp/production/okr_delivery/3038006/9781464811173.pdfen
okr.region.administrativeAfrica
okr.region.countryGhana
okr.topicHealth, Nutrition and Population::Health Economics & Finance
okr.topicHealth, Nutrition and Population::Health Insurance
okr.topicHealth, Nutrition and Population::Health Service Management and Delivery
okr.topicPoverty Reduction::Access of Poor to Social Services
okr.topicPoverty Reduction::Poverty and Health
okr.unitGHN13
relation.isAuthorOfPublication601b45de-9e7b-5045-bfef-0689612779d8
relation.isAuthorOfPublication.latestForDiscovery601b45de-9e7b-5045-bfef-0689612779d8
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