The idea for the National Health Insurance Scheme in Ghana was conceived by former president John Kufuor who when seeking the mandate of the people in the 2000 elections, promised to abolish the cash and carry system of health delivery. Under the cash and carry system, the health need of an individual was only attended to after initial payment for the service was made. Even in cases when patients had been brought into the hospital on emergencies it was required that money was paid at every point of service delivery. Upon becoming president, former president Kufuor pushed through his idea of getting rid of “cash and carry” and replacing it with an equitable insurance scheme that ensured that treatment was provided first before payment for Ghanaian citizens. In 2003, the scheme was passed into law. Under the law, there was the establishment of Ghana National Health Insurance Authority which licenses, monitors and regulates the operation of health insurance schemes in Ghana. Like many countries in the world, Ghana's health insurance was fashioned out to meet specific needs of persons resident in Ghana. The National Health Insurance Scheme is a form of social intervention established by the Government of Ghana in the year 2003. The scheme provides equitable access and financial coverage for basic health care services to residents in Ghana. The objective of the NHIS is to secure the implementation of the national health insurance policy that ensures access to basic healthcare services to all residents of Ghana.
NHIS Policy
The health insurance was set up to allow Ghanaian residents to make contributions into a fund so that in the event of illness members could be supported by the fund to receive affordable health care. Under this policy, three types of health insurance schemes were set up. They were: • The National Health Insurance Scheme. • The Private Mutual Health Insurance Scheme.
The Private Commercial Health Insurance Scheme.
In order for the system to function well, the government decided to support the District Mutual Health Insurance Scheme concept to ensure that:
Opportunity is provided for all Ghanaian citizens to have equal access to the functional structures of health insurance.
Ghanaian citizens do not move from an unaffordable ‘Cash and carry’ regime to another unaffordable Health Insurance one.
A sustainable Health Insurance option is made available to all Ghanaian citizens.
The quality of health care provision is not compromised under Health Insurance.
Premiums
Like all insurance schemes, different types of premiums are available under the country's NHIS. Ghanaian contributors are grouped according to their levels of income. Based on the group a Ghanaian contributor may fall in, there is specific premium that ought to be paid. This was done since the socio-economic condition scheme contributors is not the same and the Ghanaian contributions was to be affordable for all to ensure that nobody is forced to remain in cash and carry system. This meant that Ghanaian contributions payable could vary from one district to the other as even the disease burden was also not the same in all the districts. To ensure that all Ghanaian citizens made some contribution to the scheme, a 2.5% Health Insurance Levy on selected goods and services was passed into law so that the money collected could be put into a National Health Insurance Fund to subsidize fully paid contributions to the District Health Insurance Schemes.
Nature of the Scheme
In order to ensure the continuity of the scheme, two major lists were made. One had the all the conditions that the scheme could cover with the other the excluded conditions.
Diseases covered under the scheme
The NHIS covers about 95% of diseases in Ghana including:
However, all district-wide schemes were given the right under the law to organise their schemes to cover as many diseases and services for Ghanaian citizens as they desire, provided it was approved by the National Health Insurance Council.
Exclusion list
The NHIS has a list of conditions that are excluded in the Benefits Package. these include;
All these constitute only 5% of the total number of diseases that Ghanaian citizens suffered from.
Scheme coverage
The government supports all 212 Districts, Municipal and Sub-metro schemes in Ghana for Ghanaian citizens to the various districts to facilitate the set-up of the schemes.
Controversies
Since the inception of the scheme in 2003, there have been a lot of controversies surrounding its operation and purpose. The first one was to do with members of the opposition National Democratic Congress, whose members claimed that the scheme was one made for members of the then ruling New Patriotic Party. As such many members of NDC did not want to register with the scheme. The reverse of all the propaganda that surrounded the scheme at its inception were revisited in 2009 when the NDC took over power. The NDC during its campaign leading to the 2008 general elections promised to make the payment of premiums under the scheme a one-time event. This idea was included in the NDC's manifesto. The promise has so far not come into fruition as the date for its implementation is constantly postponed. Many critics of the proposal claim that it is just not possible to support the scheme with a one-time premium since the sustainability of the scheme would not be possible if premiums were not paid yearly. The promise could however not be implemented during the 8 year reign of the NDC.
