Exploring options for financial sustainability of Ghana’s National Health Insurance Scheme

Abstract

Even though Ghana’s National Health Insurance Scheme (NHIS) has been hailed as a success story of health financing in developing countries, it is facing serious challenges of financial sustainability. This has been attributed to several factors including low premium contribution by the informal sector, low health insurance levy (NHIL) and large exemption package. However, no study has been done to explore options for reforms to sustain the scheme. The objective of this study was to explore options for reforms to sustain Ghana’s National Health Insurance Scheme. A cross-sectional survey of five hospitals within the Greater Accra Region of Ghana was conducted. Questionnaire was administered to a total of 596 patients. Data was analysed with the aid of SPSS version 20 using descriptive statistics and chisquare analysis. The results showed that only 2 in 10 respondents approved of increasing premium as a means of raising revenue to sustain the scheme. About 4 in 10 were in favour of increasing the NHIL. About 5 in 10 were in favour of co-payment for in-patients services, while about 3 in 10 approved of copayment for out-patient services. Over 7 in 10 respondents were in favour of other forms of taxes such as company tax and sin tax. Tax sources of revenue will be the most feasible option to ensure financial sustainability of the NHIS. Increasing the NHIL from 2.5% to 4% or 5% will improve the financial position of the NHIS. Co-payments could be introduced as a temporary measure.

Keywords: health insurance, patients, exemption mechanisms, children, primary care, access