Abstract:
Health Insurance is a formal contractual arrangement between the insurer and the insured to the effect that the insurer provides cover for part or all healthcare cost of the insured as agreed between the two parties for a period of time. Ghana since 2003 has been implementing a National Health Insurance Scheme. Currently, the NHIS is facing financial sustainability issues. The scheme is heavily indebted to the service providers on average of 7 months claims reimbursement with some service providers resorting to charging unapproved fees in cash and occasional denial of services to the scheme members.
Funding to the scheme has remained unchanged over the years despite evidence suggesting otherwise. In the absence of political will to take necessary far reaching decisions, it has become critical to review the operations of the scheme to determine what can be done to improve its financial sustainability. The NHIS laws, operational data and relevant documentations were reviewed.
Fifteen key informants were interviewed for the study. It was found out that the revised NHIS law, Act 852 has exposed the NHIS to extreme financial burden relative to Act 650, membership improvement drive were focused mainly on enrolling persons in the exempt categories, delays in claims reimbursement to service providers and perceived low quality of services offered to scheme members has created enabling grounds for perpetuating frauds and abuses against the scheme and weak implementation of some policies in the health sector has not been supportive of the NHIS cost containment measures.
The study recommended to the NHIS to engaged its stakeholders to reviews the provisions on exemption, the Ministry of health to provide and ensure enabling policy environment and the government of Ghana to make additional budgetary allocation to support persons exempted from premium payment.
