Overview of NHIS

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.

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.

It is a social policy, a kind of social re-engineering that caters for the most vulnerable in the society through the principle of equity, solidarity, risk sharing, cross-subsidization, re-insurance, subscriber/ community ownership, value for money, good governance and transparency in the health care delivery.

The Vision of government in instituting the NHIS is to assure equitable and universal access for all residents of Ghana to an acceptable quality of a package of essential health care services without out of pocket payment being required at the point of service.

This way, everyone would be protected from the problems that are associated with having to find money at the time of illness before needed services can be accessed.

The NHIS replaces out of pocket payment at time of service delivery by providing a specified minimum healthcare benefit package to members.

Membership of the scheme includes people in the informal sector, SSNIT Contributors, SSNIT Pensioners, the Aged (70+), Children under 18 years of age and the Indigent. In accessing health care service under the NHIS, a beneficiary has to obey the referral system termed as ‘gate-keeper system’.

This requires the beneficiary to first report at a primary care facility, and subsequently to the second and third levels of care by way of referral.

Over 95% of disease conditions that afflict us are covered under the NHIS.

Out Patient Services

• General and specialist Consultations reviews
• General and specialist diagnostic testing including, Laboratory investigation, X-rays, Ultrasound scanning
• Medication-prescribed medicines on the NHIS Medicines list
• Surgical Operation such Hernia repair
• Physiotherapy

In Patient Service

• General and specialist in patient care
• Diagnostic tests
• Medication-prescribed medicines on the NHIS medicines list, blood and blood products
• Surgical operations
• In patient physiotherapy
• Accommodation in the general ward
• Feeding (where available)

Specific Services (Oral Health)

• Pain relief (tooth extraction, temporary incision and drainage)
• Dental restoration (simple amalgam filling, temporary dressing)

Maternity Care

• Antenatal care
• Deliveries (normal and assisted)
• Caesarean session
• Post-natal care

Emergencies

These refer to crises in health situations that demand urgent attention such as:

• Medical emergencies
• Surgical emergencies
• Paediatric emergencies
• Obstetric and gynaecological emergencies
• Road traffic accident

The following health procedures are excluded from the NHIS Benefits List:

• Appliance and Prostheses including Optical aids, Heart aids, Orthopaedic aids, dentures etc.
• Cosmetic surgeries and aesthetic treatment
• HIV Retroviral drugs (Symptomatic treatment of opportunities infections and AIDS related diseases will be not be covered)
• Assisted Reproduction (e.g. Artificial Insemination) and gynaecological hormone replacement therapy.
• Echocardiography
• Photography
• Angiography
• Dialysis for chronic renal failure
• Organ transplantation
• All drugs that are not listed on the NHIS list
• Heart and Brain Surgery other than those resulting form accidents
• Cancer treatment other than breast and cervical
• Mortuary Services
• Diagnosis and treatment abroad
• Medical examinations for purposes other than treatment in accredited health facilities (e.g. Visa application, Education, Institutional, Driving license etc)
• VIP ward (Accommodation)

Health insurance cards are the means of identifying members of the NHIS.

New uniform ID cards are being introduced which is valid for Five (5) years from the date of issue but renewable yearly upon payment of the agreed premium.

To make the NHIS accessible to all, it has been decentralised to district level. The decentralised units of the NHIS are the Mutual Health Insurance Schemes which have been established in Districts, Municipal and Sub-Metropolitan areas.

They have been equipped to enroll members within their catchment areas. Presently, 143 District/ Municipal and Sub-Metropolitan Mutual Health Insurance Schemes have officially been established throughout the country and are providing benefits to their members.

The Best Thing to Happen to Ghana.

Within a space of two years of actual implementation, (2005-2007) the NHIS has achieved about fifty per cent national coverage which is one of the highest rate of registration in the world.

All across Ghana, card-bearing members of the schemes are getting treated free of charge for ailments and conditions that would have cost them millions of Cedis under the cash and carry system.

Registered women attend antenatal clinics and their babies are delivered free of charge. Women are undergoing fibroid operation, breast and cervical cancer treatment with their NHIS cards as passport to free health care.

Men especially those in the rural areas who had long suffered from hernia are getting treated at no cost. People with chronic diseases such as diabetes testify to the immense benefit of the scheme as they pay nothing towards the high cost of the medication.

The highest amount paid by the Scheme towards the cost of care of an individual member is GH¢9,500 (95 million Cedis).

A recent survey carried out on the Dangbe West District Mutual Health Insurance Scheme in the Greater Accra Region by the International Labour Organisation (ILO) showed a very positive impact of the scheme on members.

Eighty-nine per cent of members of the scheme interviewed during the survey said they had easy access to government Clinic. Sixty-Six per cent had access to chemist or pharmacies whilst 32 per cent said they had access to private clinics.

An analysis of the survey indicated that 81% of the people considered the benefits adequate whilst only eight per cent said they were inadequate.

Eighty-five per cent of the people said the National Health Insurance Scheme is better than the Cash and Carry system.

Compared to other countries Ghana has every reason to be proud of its progress in the implementation of the NHIS so far. Fifty per cent nationwide coverage within two years is certainly very good progress.

Most advanced countries that have been practicing health insurance for decades have not been able to achieve one hundred per cent coverage.

These are countries where beneficiaries of health insurance pay part of the cost of care at the point of service. Here in Ghana the scheme and the state are bearing the full cost of care to every registered member.

The cost burden is therefore greater on the government of Ghana than even in the rich countries. Again the premium paid to the scheme in Ghana is one of the cheapest in the world.

Government founded the National Health Insurance Scheme as one of the key pillars of the Poverty Reduction Programme. The scheme so far has lived up to this responsibility.

It remains the best and most secure social welfare package that the state is providing its citizens. Over sixty per cent of the members are accessing free health care without paying premium. These are children below 18 the aged above 70, and the very poor called indigents.

At about fifty per cent coverage hospital attendance has jumped to astronomical heights. The facilities are chocked and under severe pressure from poor people for whom the cash and carry system had been a barrier to health care.

To better appreciate what Ghana has achieved with NHIS we have to remind ourselves where we are coming from. In the 1980s the World Bank recommended to African countries to institute cost recovery in health care delivery. This led to the introduction of medical facilities user fees on the continent and in the case of Ghana, the Cash and Carry system.

The result of this system was very low uptake of orthodox health services in the country while self medication and patronage of herbal medicine became the order of the day for the poor. These in turn led to a very high incidence of preventable deaths.

This is what the National Health Insurance Scheme has come to replace and completely do away with. As a nation we do not ever want to return to this sad state of affairs in our health care delivery. Our mission is simple, to sustain the NHIS at all cost for the present and future generations.

For more information click on any of the links below.