Using National Health Insurance to Finance Health Care: Ghana s. Experience. Research Associate, NHIA. Francis Asenso-Boadi

Transcription

1 Using National Health Insurance to Finance Health Care: Ghana s Experience Francis Asenso-Boadi Research Associate, NHIA

2 Introduction The National Health Insurance Scheme (NHIS) was introduced in 2003 by the National Health Insurance Act, 2003 (Act 650) with the view to improving financial access of Ghanaians, especially the poor and the vulnerable, to quality basic health care services.

3 Introduction Cont. Under the NHIS, the rich subsidizes the poor, the healthy subsidizes the sick and the economically active pays for children, the aged and the indigents.

4 Schemes The National Health Insurance Act 2003 (Act 650) sets out three (3) distinct types of health insurance schemes that may be established and operated in Ghana.

5 Types of Schemes allowed by law District mutual health insurance schemes Private commercial health insurance schemes Private mutual health insurance schemes.

6 To operate as a health insurance scheme in Ghana, the scheme must first be registered under the Companies Code (Act 179), as a company limited by guarantee or shares.

7 Thereafter, the health insurance scheme has to apply to the National Health Insurance Authority (NHIA) for registration and licensing.

8 National Health Insurance Authority s Mandate The Authority is to secure the implementation of a national health insurance policy that ensures access to basic healthcare services to all residents It regulates the schemes

9 The National Health Insurance Authority The National Health Insurance Authority is made up of the following Divisions and Departments: Operations Research and Development Administration and Legal Information and Communication Technology (ICT) Finance Corporate Affairs Internal Audit

10 NHIA Departments & Divisions In addition, the Authority has 10 Zonal (Regional) Offices which are an extension of the Operations Division.

11 INTERNAL AUDIT The office of the internal auditor exists to assure the integrity of the NHIA activities.

12 Internal Audit - Activities: Periodic audit of National Health Insurance Fund. Operational audit of the activities of the NHIA and the Schemes Provision of consulting services to NHIA Liaison with external bodies on audit issues, such as external auditors of Secretariat and Schemes Maintenance of an audit recommendations follow-up system. Special investigations into particular areas, for example fraud.

13 OPERATIONS - Activities: Supervise, co-ordinate and monitor the activities of health insurance schemes. Provide support to service providers to render quality services at all times. Enforce utilization and cost control measures at the scheme level. Collaborate with relevant stakeholders to achieve the co-operate objectives of the council. Facilitate the scaling up of membership registration.

14 RESEARCH & DEVELOPMENT - Activities: Lead the review of tariff structure. Lead the review of National Health Insurance drug formulary. Conduct research in areas that enhance the implementation of NHIS policy e.g. defining quality health care, determining socio-economic status accurately, sustainability of Health Insurance cost-containment mechanisms. Coordinate research being done across the country especially in the area of health finance and act as the first point of call for all such research. Collaborate with development partners and coordinate their efforts in accordance with the SWAP approach.

15 FINANCE - Activities Preparation and Management of NHIA Budget Keep and maintain proper financial records of NHIA Receiving money and disburses for NHIA Prepare financial policies of NHIA Prepare Financial reports of all the Schemes Provide Financial Advice to the Chief Executive(NHIA) Prepare returns on Employee / Employer SSNIT Contribution Fixed Assets Management Undertake proper Inventory Control.

16 INFORMATION & COMMUNUICATION TECHNOLOGY - Activities Providing ICT support to all users Maintenance and update of schemes data Providing ICT training for all officers nation-wide Supply and maintenance of ICT equipment Implementation of ICT related projects

17 CORPORATE AFFAIRS - Activities Educating all residents of Ghana and Ghanaians abroad on the NHIS. Ensuring good relationship among the Authority, Schemes and the Media. Ensuring the best of relations between the Authority, Schemes and other stakeholders. Planning and executing effective Marketing and Publicity programmes. Receiving feedback from the public and responding to suggestions and complaints. Organizing public functions of the Authority Arranging for officials of the Authority and the Schemes to attend functions. Securing protocol and other needs of Authority staff. Procuring and disseminating information, education and communication.

18 NHIS Benefits Package Over 95% of disease conditions that afflict us are covered by the NHIS. OPD; IPD (including feeding), Diagnostics; Medicines (generics) All emergencies are covered

19 Membership Registration To become a member of the, one needs to be registered and issued with a Health Insurance Membership ID Card. One needs to pay the appropriate premium (except those belonging to the exempt group) to benefit from the National Health Insurance Scheme.

20 Membership Premium Ranges from GH 7.20 for the poor to GH 48 for the rich

21 The exempt group comprises: SSNIT Contributors SSNIT Pensioners People aged 70 years and above Children under 18 years Indigents

22 Membership Registration Registration of Members can be done at the DMHIS office, designated points or by Registered Agents and Scheme Officers who call at homes and work places. NHIS Membership ID Card shall be generated after the waiting period.

23 Membership Registration cont. Upon the issuance of a membership ID card, each Member shall be given: A booklet containing membership rights, obligations and privileges List of Healthcare Benefits under the Scheme List of Accredited Healthcare Providers

24 RENEWAL OF MEMBERSHIP The NHIS Membership Renewal applies to all registered Members of a DMHIS who have been issued with a MEMBERSHIP ID CARD. A member shall apply for renewal three months prior to the expiration of the ID Card. Renewal is done at the DMHIS office or by an Agent of the scheme.

25 Implementation NHIS Purpose The National Health Insurance Scheme was founded as one of the key pillars of Ghana s Poverty Reduction Programme. So far, the scheme has lived up to this responsibility. Evidence?

26 Comparative Analysis Country/Variabl Ghana Chile Philippine Taiwan Bolivia es Inception % Population Covered Funding Source Benefit Package Near a) 2.5% tax-base (NHIL) b)2.5% SSNIT; c) informal sector Gh Gh 48 per annum Comprehensive (95%) OPD, IPD, Diagnostics, NHIS-approved medicines 7% - 11% payroll deductions 6% of Salary - employee 3% and employer 3%; Voluntary contributors pay $29 monthly OPD/IPD IPD beyond 24hrs, OPD; Medicines while on admission, Medicines for OPD reimburese 4.5% Pay-roll deductions No ceiling but costly/high tech treatments need authorisation, OPD, IPD & Diagnostics Premium Determination Co-payments No Yes Yes Yes Yes Tax funded + premium to cover admin expenses Primary care, prescription drugs, lab tests and maternity services Not Risk-adjusted Risk-adjusted Risk-adjusted Risk-adjusted Risk-adjusted

27 Performance cont. The NHIS seems to be very generous compared to schemes in other countries some of them relatively richer than Ghana

28 Implementation cont. At the inception of the scheme, the target was to achieve 40 per cent nationwide registration by the end of By the first quarter of 2008 about 55% of the population had been registered. Sixty-two per cent of the members are accessing free health care without paying premium.

29 Performance so far Ist Quarter Schemes in Operation 145 Total Registered 11,279,678 55% Members eligible for ID 9,773,100 48% Cards Informal Adult 2,456,012 25% 70 years and above 405,474 4% Under 18 years 5,985,152 61% SSNIT Contributors 625, % Pensioners 52,300 1% Indigents 248, % ID Card Bearers 8,291,666 42%

30 Utilization Levels YEAR Hospital/Clinic Attendance Active Members ,000 1,388, ,213,450 3,955, ,835,104 8,291,666

31 Challenges Limited Facilities Available Accredited Private Providers Sept Category of Providers Number Accredited Hospitals/Clinics 301 Dental Clinics 7 Maternity Homes 201 Pharmacies 301 Chemical Shops 229 Diagnostic Centres 96 Total Accredited 1135

32 Challenges cont. Lack of portability Non-standardized scheme operations Limited scope of NHIS approved medicines Potential for fraud by member/scheme/provider

33 Challenges Cont. Inadequate human capital Linkage of children s registration to that of their parents Difficulty in identifying accredited providers Communication gap between NHIA and stakeholders

34 Strategic Initiatives New ID Card

35 Strategic Initiatives cont. Review of Tariff Structure & Medicines List Introduction of Ghana-DRGs as an alternative provider re-imbursement mechanism Introduction of logo for identification of NHISaccredited providers

36 Strategic Initiatives cont. Free registration of pregnant women Decoupling of children from their parents

37 Expected Outcomes Easy registration and issuance of ID cards becoming permanent features of the NHIS NHIA transformed into a solution-based organization Sustainability of the scheme

38 Expected Outcomes cont. Attainment of universal awareness of NHIS brand The Plan and Membership benefits become fully portable Quality of services significantly improved at both scheme and provider levels.

39 END OF PRESENTATION END OF PRESENTATION THANK YOU