National Health Insurance Scheme (Ghana)
The National Health Insurance Scheme (NHIS) in Ghana is a social health insurance program established by Act 650 of 2003, which was later replaced by Act 852 of 2012. Its primary objective is to provide equitable access to healthcare services for all residents of Ghana, regardless of their socio-economic status. The NHIS aims to reduce the financial barriers that prevent people from seeking necessary medical attention, thereby improving the overall health and well-being of the population.
The scheme is administered by the National Health Insurance Authority (NHIA), an agency responsible for the registration of members, accreditation of healthcare providers, benefit package definition, and financial management of the scheme. Funding for the NHIS is derived from several sources, including a 2.5% National Health Insurance Levy (NHIL) charged on goods and services subject to Value Added Tax (VAT), contributions from formal sector workers through Social Security and National Insurance Trust (SSNIT), premiums from informal sector subscribers, and government budgetary support.
Membership in the NHIS is open to all residents of Ghana. Children under 18 years of age, pensioners, and indigents are exempt from paying premiums. Individuals can register at NHIS district offices across the country. After registration and payment of premiums (where applicable), members receive a National Health Insurance card, which grants them access to a comprehensive package of healthcare services at accredited healthcare facilities.
The benefit package covers a wide range of medical services, including outpatient care, inpatient care, maternity care, eye care, dental care, and some chronic disease management. However, there are some exclusions, such as cosmetic surgery and certain specialized treatments. The NHIA reimburses healthcare providers for services rendered to NHIS members based on agreed-upon tariffs.
The NHIS has faced challenges since its inception, including issues related to financial sustainability, quality of care, delays in reimbursement to healthcare providers, and coverage disparities. Efforts are ongoing to address these challenges and improve the efficiency and effectiveness of the scheme. These efforts include strengthening the NHIA's administrative capacity, expanding the benefit package, improving the quality of care at accredited facilities, and exploring alternative financing mechanisms. The NHIS remains a central component of Ghana's efforts to achieve universal health coverage.