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

Ghana 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. How...

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Main Authors:	Wang, Huihui, Otoo, Nathaniel, Dsane-Selby, Lydia
Format:	Book
Language:	English en_US
Published:	Washington, DC: World Bank 2017
Subjects:	GHANA EFFICIENCY HEALTH INSURANCE FINANCIAL SUSTAINABILITY EXPENDITURE CONTROL HEALTH FINANCING COST CONTAINMENT DEVELOPING COUNTRY
Online Access:	http://hdl.handle.net/10986/27658

id	okr-10986-27658
recordtype	oai_dc
spelling	okr-10986-276582021-04-23T14:04:46Z Ghana National Health Insurance Scheme : Improving Financial Sustainability Based on Expenditure Review Wang, Huihui Otoo, Nathaniel Dsane-Selby, Lydia GHANA EFFICIENCY HEALTH INSURANCE FINANCIAL SUSTAINABILITY EXPENDITURE CONTROL HEALTH FINANCING COST CONTAINMENT DEVELOPING COUNTRY Ghana 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. 2017-07-31T14:50:52Z 2017-07-31T14:50:52Z 2017-07-31 Book 978-1-4648-1117-3 http://hdl.handle.net/10986/27658 English en_US World Bank Studies; CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank Washington, DC: World Bank Publications & Research Publications & Research :: Publication Africa Ghana
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English en_US
topic	GHANA EFFICIENCY HEALTH INSURANCE FINANCIAL SUSTAINABILITY EXPENDITURE CONTROL HEALTH FINANCING COST CONTAINMENT DEVELOPING COUNTRY
spellingShingle	GHANA EFFICIENCY HEALTH INSURANCE FINANCIAL SUSTAINABILITY EXPENDITURE CONTROL HEALTH FINANCING COST CONTAINMENT DEVELOPING COUNTRY Wang, Huihui Otoo, Nathaniel Dsane-Selby, Lydia Ghana National Health Insurance Scheme : Improving Financial Sustainability Based on Expenditure Review
geographic_facet	Africa Ghana
relation	World Bank Studies;
description	Ghana 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.
format	Book
author	Wang, Huihui Otoo, Nathaniel Dsane-Selby, Lydia
author_facet	Wang, Huihui Otoo, Nathaniel Dsane-Selby, Lydia
author_sort	Wang, Huihui
title	Ghana National Health Insurance Scheme : Improving Financial Sustainability Based on Expenditure Review
title_short	Ghana National Health Insurance Scheme : Improving Financial Sustainability Based on Expenditure Review
title_full	Ghana National Health Insurance Scheme : Improving Financial Sustainability Based on Expenditure Review
title_fullStr	Ghana National Health Insurance Scheme : Improving Financial Sustainability Based on Expenditure Review
title_full_unstemmed	Ghana National Health Insurance Scheme : Improving Financial Sustainability Based on Expenditure Review
title_sort	ghana national health insurance scheme : improving financial sustainability based on expenditure review
publisher	Washington, DC: World Bank
publishDate	2017
url	http://hdl.handle.net/10986/27658
_version_	1764465652068777984

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

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